Original Article
On-Pump versus Off-Pump Coronary-Artery Bypass Surgery
N Engl J Med 2009; 361:1827-1837November 5, 2009
- Abstract
Background
Coronary-artery bypass grafting (CABG) has traditionally been performed with the use of cardiopulmonary bypass (on-pump CABG). CABG without cardiopulmonary bypass (off-pump CABG) might reduce the number of complications related to the heart–lung machine.
Methods
We randomly assigned 2203 patients scheduled for urgent or elective CABG to either on-pump or off-pump procedures. The primary short-term end point was a composite of death or complications (reoperation, new mechanical support, cardiac arrest, coma, stroke, or renal failure) before discharge or within 30 days after surgery. The primary long-term end point was a composite of death from any cause, a repeat revascularization procedure, or a nonfatal myocardial infarction within 1 year after surgery. Secondary end points included the completeness of revascularization, graft patency at 1 year, neuropsychological outcomes, and the use of major resources.
Results
There was no significant difference between off-pump and on-pump CABG in the rate of the 30-day composite outcome (7.0% and 5.6%, respectively; P=0.19). The rate of the 1-year composite outcome was higher for off-pump than for on-pump CABG (9.9% vs. 7.4%, P=0.04). The proportion of patients with fewer grafts completed than originally planned was higher with off-pump CABG than with on-pump CABG (17.8% vs. 11.1%, P<0.001). Follow-up angiograms in 1371 patients who underwent 4093 grafts revealed that the overall rate of graft patency was lower in the off-pump group than in the on-pump group (82.6% vs. 87.8%, P<0.01). There were no treatment-based differences in neuropsychological outcomes or short-term use of major resources.
Conclusions
At 1 year of follow-up, patients in the off-pump group had worse composite outcomes and poorer graft patency than did patients in the on-pump group. No significant differences between the techniques were found in neuropsychological outcomes or use of major resources. (ClinicalTrials.gov number, NCT00032630.)
Media in This Article
Figure 1
Enrollment, Randomization, and Follow-up of Patients.Figure 2
Kaplan–Meier Estimates of Survival after Surgery.Article Activity
- Article
During the past 30 years, coronary-artery bypass grafting (CABG) primarily was performed with the use of cardiopulmonary bypass (“on pump”) with cardioplegic arrest. Historically, on-pump CABG was shown to improve ischemic symptoms and, in selected patients, prolong survival.1-3 In the mid-1990s, interest emerged in performing CABG without the use of cardiopulmonary bypass (off pump), in order to reduce postoperative complications associated with the use of cardiopulmonary bypass,4-7– including generalized systemic inflammatory response,8,9, cerebral dysfunction,10-12– myocardial depression, and hemodynamic instability. 13,14
At the time this trial was being planned, initial enthusiasm for off-pump CABG became tempered by concern about the completeness of revascularization, the rate of perioperative myocardial infarction, and long-term graft patency.15-17 Therefore, to further assess the relative efficacy of on-pump and off-pump CABG, the Department of Veterans Affairs (VA) Cooperative Studies Program funded the Randomized On/Off Bypass (ROOBY) trial (Cooperative Studies Program number 517) as a prospective study designed to evaluate the primary outcomes of major morbidity and mortality at both 30 days and 1 year and the secondary outcomes of completeness of revascularization, 1-year graft patency, neuropsychological test scores, and other outcomes. We hypothesized that there would be no difference between the on-pump and off-pump procedures for the two primary outcomes.
Methods
Study Design
The ROOBY trial was a controlled, single-blind, randomized trial conducted from February 2002 through May 2008 at 18 VA medical centers (see the Supplementary Appendix, available with the full text of this article at NEJM.org). The trial was designed by the principal investigators (with oversight by a planning committee), sponsored by the VA Cooperative Studies Program, approved by the institutional review board of each participating VA medical center, and assessed routinely by an independent data and safety monitoring board. All participants provided written informed consent.
Before patients underwent randomization, participating surgeons were required to document that they had performed at least 20 off-pump CABG surgeries, including some in which complete revascularization was performed for all vascular territories of the heart. The prestudy off-pump experience of the surgeons averaged 120 cases (median, 50). Sixteen sites had training programs in which cardiothoracic trainees (postgraduate year 6 to 10) were designated before randomization as the primary surgeon or first assistant surgeon. Postoperatively, enrolled patients were followed every 2 months for up to 1 year.
Baseline and follow-up angiograms and neuropsychological tests were assessed and scored by angiographic and neuropsychological core-laboratory staff who were unaware of the treatment assignment. Data collection, analysis, and reporting were performed by the VA Cooperative Studies Program Coordinating Center at Perry Point, Maryland.
Selection of Patients and Randomization
Patients who were scheduled for urgent or elective CABG-only procedures were screened for enrollment. Exclusion criteria were any clinically significant valve disease (i.e., moderate, moderate-to-severe, or severe valve disease), a status requiring immediate surgery, small target vessels (<1.1 mm in internal diameter) or diffuse coronary disease, clinical reservations of the surgical team regarding patients with risk-factor profiles that predisposed them to an extremely high risk of an adverse event, or the inability or unwillingness of the patient to provide consent. While in the preoperative holding area, patients underwent randomization with the use of an automated central telephone system in a blocked randomization scheme. Assignments of the patients were balanced for each attending surgeon.
Treatment
A standard median sternotomy was performed in all patients. Protocol details have been published previously.18 During the trial, various stabilization devices were used during off-pump surgery to provide a motionless surgical field. The use of one of these devices was required. Conversion from the assigned procedure to the other procedure was performed when clinically necessary.
Study End Points
The primary short-term end point was a composite of death or major complications (reoperation, new mechanical support, cardiac arrest, coma, stroke, or renal failure requiring dialysis) occurring within 30 days after surgery or before discharge, whichever was later. The primary long-term composite end point was death from any cause within 1 year, nonfatal myocardial infarction between 30 days and 1 year, or repeat revascularization between 30 days and 1 year. Composite end points were selected for feasibility and fiscal reasons. Secondary end points included the completeness of revascularization (determined by the number of grafts performed as compared with the number planned), graft patency at 1 year, and scores on a battery of neuropsychological tests (derived from previously published tests), which were performed preoperatively and 1 year postoperatively.
Statistical Analysis
The required sample size of 2200 patients was based on the use of a two-tailed continuity-corrected chi-square test, a P value of 0.05 to indicate statistical significance for primary end points, a power of 0.80, a 10% rate of loss to follow-up, and the ability to detect a reduction of 40% in the rate of the primary 1-year composite end point in the off-pump group as compared with the expected 8% rate in the on-pump group. This sample size also allowed the detection of a 30% reduction in the primary short-term composite end point from the expected 14% rate in the on-pump group. The two primary end points were analyzed with the use of continuity-corrected chi-square tests. Mantel–Haenszel chi-square tests were used to adjust for study-center effects. Baseline characteristics and secondary outcomes were compared with the use of chi-square techniques and t-tests as appropriate. Log-rank tests with Kaplan–Meier curves were used to report time to death. For secondary outcome measures, a P value of 0.01 was considered to indicate statistical significance. Confidence intervals were reported for all outcome measures.
Results
Enrollment and Randomization
From February 2002 through May 2007, a total of 9663 patients who were scheduled for urgent or elective CABG were screened for enrollment (Figure 1Figure 1
Enrollment, Randomization, and Follow-up of Patients.). Of these, 7460 patients (77.2%) were excluded, most commonly because of diffusely diseased or small coronary arteries (2716 patients), a surgeon who was not participating in the study or a coordinator who was unavailable to enroll the patient (2461), and the unwillingness or inability of the patient to provide consent (1467). More excluded patients than enrolled patients had chronic obstructive pulmonary disease (22.8% vs. 20.8%), renal insufficiency (12.2% vs. 7.9%), peripheral vascular disease (19.0% vs. 15.5%), hypertension (88.5% vs. 86.2%), and previous CABG (4.0% vs. 0.6%). Enrolled patients had a lower predicted risk of death before discharge or within 30 days after the procedure than those who were excluded (1.9% vs. 2.5%, P<0.001). About 15% of enrolled patients were categorized as having urgent status but not requiring immediate surgery.Overall, 2203 patients were randomly assigned to either on-pump surgery (1099 patients) or off-pump surgery (1104 patients). Baseline demographic and clinical characteristics were similar in the two groups and consistent with those of the overall VA CABG population (Table 1Table 1
Baseline and Operative Characteristics of Patients Undergoing Off-Pump or On-Pump CABG.). Most patients were white men who were current or former smokers and had at least one coexisting condition. More than 40% of the patients had diabetes mellitus. A majority of patients had three-vessel coronary artery disease and normal left ventricular function. There was no significant difference between patients in the off-pump group and those in the on-pump group in the predicted risk of death before discharge or within 30 days after the procedure (1.9% and 1.8%, respectively; P=0.25).Other than the use of myocardial preservation and aortic cross-clamping in the on-pump group, the study protocol required that surgical techniques and intraoperative monitoring be consistent; the use of Swan–Ganz catheters occurred 93% of the time in each group, and the use of optional transesophageal echocardiography occurred 68% of the time in each group. However, patients in the on-pump group were more likely than those in the off-pump group to have had the cardiothoracic resident as the primary surgeon (64.0% vs. 55.4%, P<0.01). Conversion to the off-pump procedure occurred in 40 patients in the on-pump group (3.6%), and conversion to the on-pump procedure occurred in 137 patients in the off-pump group (12.4%).
Primary Composite End Points
There was no significant difference between the off-pump group and the on-pump group in the rate of the primary short-term (30-day) composite end point (7.0% and 5.6%, respectively; P=0.19). The rate of death from any cause before discharge or within 30 days after the procedure was 1.6% in the off-pump group and 1.2% in the on-pump group (P=0.47). Major complications were also low in number and similar in the two treatment groups (Table 2Table 2
Short-Term and Long-Term Primary End Points According to Treatment Group.).The primary long-term (1-year) composite end point was determined in 2111 of the patients (95.8%). The VA death registry provided the 1-year survival status for all patients. The rate of the long-term composite outcome was higher in the off-pump group than in the on-pump group (9.9% vs. 7.4%, P=0.04). No significant differences were found for any of the individual components of the 1-year composite end point. There was a trend toward more deaths from cardiac causes in the off-pump group than in the on-pump group (2.7% vs. 1.3%, P=0.03) (Table 2).
To ensure that the long-term composite findings were robust, sensitivity analyses were performed. We replaced death from any cause with death from cardiac causes, and we replaced myocardial infarction or repeat revascularization between 30 days and 1 year after CABG with cumulative 1-year events from the time of surgery for nonfatal myocardial infarction and revascularization procedures. These sensitivity analyses showed even stronger advantages for on-pump procedures (Table 2). Despite better 1-year composite outcomes in the on-pump group, Kaplan–Meier analysis for death from any cause, reported as of May 2008, showed no significant difference in survival between off-pump and on-pump treatments (P=0.25) (Figure 2Figure 2
Kaplan–Meier Estimates of Survival after Surgery.).Since the primary analysis was based on the intention-to-treat principle, a supplementary analysis excluded all patients for whom the assigned procedure was converted to the other procedure. For patients who underwent the assigned procedure, without conversion to the other procedure (928 patients in the off-pump group and 1013 in the on-pump group), the directionality of the 1-year primary end point remained consistent between the off-pump and on-pump groups but did not reach statistical significance (9.4% and 7.1%, respectively; P=0.08).
Major Secondary End Points
Completeness of Revascularization
Before randomization, the participating surgeons recorded the planned target arteries for the coronary-artery bypass. Most CABG procedures were planned as two-vessel (23%), three-vessel (45%), or four-vessel (24%) procedures. The number of bypasses planned was the same in the two groups (mean [±SD] number of bypasses per patient, 3.0±0.9). There was a significant difference between the off-pump group and the on-pump group in the average number of bypasses performed per patient (2.9±0.9 and 3.0±1.0, respectively; P=0.002). The proportion of patients with fewer grafts than originally planned was higher in the off-pump group than in the on-pump group (17.8% vs. 11.1%, P<0.01) (Table 1).
Graft Patency
Of the 2127 patients who underwent CABG and were alive at 12 months, 1371 (64.5%) had follow-up angiograms; 1335 had angiograms at the 12-month end-of-study visit, and 36 patients had only an interim angiogram. Of the 759 surviving patients with no follow-up angiograms, 573 (75.5%) declined angiography, 52 had an elevated creatinine level, 55 moved or did not want to travel, 32 had unidentified reasons, and 47 were lost to follow-up. There were no significant differences between the study groups in the reasons for missing follow-up catheterization. Also, there were no significant differences between the treatment groups in baseline clinical and demographic characteristics for patients who underwent follow-up angiography.
Grafts were evaluated for patency (open vs. closed) and assigned a FitzGibbon grade of A (excellent graft), B (impaired graft, with ≥50% stenosis and a reduction in the caliber of the graft to <50% of the grafted artery), or O (100% occluded graft).19 Overall, 4093 grafts were analyzed: 1253 left internal thoracic-artery pedicle grafts to the left anterior descending artery, 2601 saphenous-vein grafts, 112 radial-artery grafts, 60 left internal thoracic-artery grafts to other arteries, 64 right internal thoracic-artery or free left internal thoracic-artery grafts, and 3 other grafts (Table 3Table 3
Core-Laboratory Results of Angiographic Tests.).The rate of graft patency was significantly lower in the off-pump group than in the on-pump group (82.6% vs. 87.8%, P<0.01). The lower rate of patency of saphenous-vein grafts in the off-pump group than in the on-pump group (76.6% vs. 83.8%, P<0.01) accounted for most of this difference. The patency rate for left internal thoracic-artery pedicle grafts to the left anterior descending artery was similar in the off-pump group and the on-pump group (95.3% and 96.2%, respectively; P=0.48). However, when left internal thoracic-artery grafts to the left anterior descending artery were classified according to the FitzGibbon grade, there were fewer grade A grafts in the off-pump group than in the on-pump group (89.0% vs. 93.2%, P=0.01).
Finally, more patients in the off-pump group than in the on-pump group had at least one occluded graft (36.5% vs. 28.7%, P<0.01). For patients with no occluded grafts, the rate of the primary 1-year composite outcome was higher in the off-pump group than in the on-pump group (6.4% vs. 3.3%, P=0.03), perhaps because there was less complete revascularization in the off-pump group.
Neuropsychological Outcomes
The battery of neuropsychological tests was designed to evaluate dysfunction in attention, memory, and visuospatial skills. Test data from the study sites were rescored at a core laboratory to ensure excellent reliability.20 Of the 2203 patients who underwent randomization, 892 of 1104 patients in the off-pump group (80.8%) and 909 of 1099 patients in the on-pump group (82.7%) completed baseline (i.e., preoperative) neuropsychological testing. Baseline tests were missing for 402 patients; the primary reasons included scheduling problems (267 patients), lack of physical ability to be tested (62), and patients who declined testing (54).
Of the 1801 patients who completed baseline testing, 1331 (73.9%) also underwent testing 12 months after surgery. Analysis of z scores was based on matched assessments of each patient's baseline and follow-up tests. Of the 1331 patients whose baseline and 1-year tests were matched, 175 were excluded because at least 1 of the 10 test measures was missing. Patients missed 1-year evaluations because, among other reasons, study participation was terminated early (198 patients), the patient was not available for testing (110), or the patient declined (78). There was no significant difference between treatment groups in follow-up rates or reasons for missed tests.
Neuropsychological data for the 1156 patients with complete and matched test measures at baseline and at 1 year of follow-up (54.3% of the 2127 survivors) were analyzed (Table 4Table 4
Core-Laboratory Results of Neuropsychological Tests.). This number of records represents a sample size that allows detection of a difference as small as 0.20 SD, with a power of 80 and a P value of 0.01 indicating statistical significance, which was equivalent to a difference of 0.07 for the global z score (the sum of all the z scores for each patient÷10). As compared with patients with nonmatched baseline and 1-year records, the 1156 patients were younger (P<0.01), were more likely to be white (P=0.04), and had a lower estimated risk of 30-day operative death (P<0.001). There were no significant differences between the treatment groups in age, education, medical characteristics, or the Beck Depression Inventory score; there were significant but not clinically relevant differences in three baseline cognitive scores. There was no significant difference between the two treatment groups in the global z score from baseline to follow-up. Only the clock-drawing test showed a statistically significant (but probably not a clinically significant) improvement in the off-pump group. Most notably, the long-term postoperative changes in individual test scores were similar to or improved from baseline for both treatment groups.Resource Use
Patients in the off-pump group required red-cell transfusions less frequently and had slightly longer operating-room times than did patients in the on-pump group. No significant differences were shown for postoperative length of stay in the surgical intensive care unit, postoperative length of stay in the hospital, or postoperative length of time on a ventilator (Table 1). Furthermore, no differences were found for the rate of rehospitalization within 30 days after surgery or the use of fresh-frozen plasma, platelets, or cryoprecipitate.
Discussion
The ROOBY trial was a large, randomized, controlled study of off-pump versus on-pump CABG. The majority of previous trials have included smaller patient cohorts (e.g., <250 patients per treatment group), a smaller number of participating centers (e.g., <3 facilities), or both.21 In our trial, 2203 patients underwent randomization, and 53 attending surgeons at 18 participating centers were involved.
Generally, off-pump CABG has been shown to be a safe and effective technique.21-23 Like the Octopus (ClinicalTrials.gov number, NCT00189215) and PRAGUE-4 multicenter trials,24,25 our trial showed no significant difference in the early composite outcome of death or complications. Several studies indicate that surgeons in a single center or a single surgeon may perform off-pump CABG with excellent results.26-29 In our trial, however, 1-year composite outcomes, completeness of revascularization, and graft patency were significantly worse with off-pump than with on-pump CABG. Given concern that outcomes may have been influenced by the surgeon's experience, a sensitivity analysis based on classifying participating surgeons as either high-volume or low-volume operators (>50 or ≤50 prestudy cases of off-pump CABG, respectively) showed no significant difference in the primary 30-day and 1-year composite outcomes, supporting the idea that these results may be generalized to surgeons with variable off-pump experience.
The majority of patients in our trial had multivessel disease. Complete revascularization was the goal, and in both groups the average number of grafts planned was 3.0 per patient. There tended to be less complete revascularization with off-pump CABG (mean, 2.9 grafts completed per patient) than with on-pump CABG (mean, 3.0 per patient). Furthermore, patients in the off-pump group were more likely than those in the on-pump group to have fewer grafts completed than had been planned.
As in smaller randomized trials involving surgeons who were experienced in off-pump CABG, the rate of patency of left internal thoracic-artery grafts to the left anterior descending artery in our trial was excellent (about 95% in each group). This finding was similar to findings by Widimsky et al.,25 who reported an arterial-graft patency rate of 91% for both techniques, and Puskas et al.,26 who reported arterial-graft patency rates of 94.1% for off-pump CABG and 98.1% for on-pump CABG. The 1-year patency rate for saphenous-vein grafts was 80% in our trial, which is similar to previously reported rates. As in smaller studies, the rate of saphenous-vein-graft patency was significantly better in the on-pump group than in the off-pump group (83.8% vs. 76.6%, P<0.001).25,26,29
The early literature indicated that off-pump approaches had the potential to improve neuropsychological outcomes. Despite loss to follow-up at 1 year, our trial had sufficient power to show differences between treatments in terms of neuropsychological outcomes. However, we found no significant differences between the groups. This is an important finding, because the results of a number of studies have suggested that cardiopulmonary bypass causes permanent neurologic dysfunction or decreases cognition and motor abilities.4,10-12,29,30 Our trial did not show a cognitive decline within 1 year after surgery in either group. Studies involving cardiac or surgical controls, or both, have shown that on-pump CABG procedures may not be the main element associated with cognitive decline.31-33 Future studies with neuropsychological control groups are warranted to evaluate the frequency of cognitive impairment or improvement over time.
Our study population consisted almost exclusively of men. Otherwise, the findings of the trial can be extrapolated to low-to-moderate-risk patients undergoing CABG only and having multiple noncardiac coexisting conditions and multivessel disease. A potential bias was that the role of the primary surgeon was not balanced between treatment groups. Residents were somewhat more likely than attending physicians to perform on-pump rather than off-pump procedures. However, an analysis of the primary 30-day and 1-year composite outcomes showed no significant differences between treatment groups, regardless of whether the resident or the attending physician was the primary surgeon.
In conclusion, our trial did not show any overall advantage to the use of the off-pump as compared with the on-pump cardiac surgical approach for coronary bypass. Instead, there was a consistent trend toward better outcomes in patients undergoing the conventional on-pump CABG technique, including better 1-year composite outcomes and 1-year patency rates. Moreover, no significant differences between the off-pump and the on-pump techniques were identified in neuropsychological outcomes or the use of major resources.
Supported by the Cooperative Studies Program of the Department of Veterans Affairs (VA) Office of Research and Development and the VA Central Office, Office of Patient Care Services, and in part by the Offices of Research and Development at the Eastern Colorado Health Care System VA Medical Center, Denver, and the Northport VA Medical Center, Northport, NY.
No potential conflict of interest relevant to this article was reported.
Source Information
From the Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S.); the Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., F.L.G., B.H., J.H.B.), and National Jewish Health (E.K.) — both in Denver; the Departments of Surgery (F.L.G.) and Medicine (B.H., E.K.), School of Medicine, University of Colorado Denver, Aurora; the Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); the Department of Veterans Affairs, Office of Patient Care Services, Washington, DC (G.O.M.); the Charles George VA Medical Center, Asheville, NC (J.C.L.); and the James A. Haley Veterans Hospital and the Department of Surgery, University of South Florida — both in Tampa (D.N.).
Address reprint requests to Dr. Collins at the Cooperative Studies Program Coordinating Center (CSPCC 151E), Boiler House Rd., Bldg. 362T, Perry Point, MD 21902, or at joseph.collins2@va.gov.
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CrossRef | Web of Science | Medline
- Citing Articles (124)
Citing Articles
1
J. M. Albes. (2012) Einzel- oder Sequenzialvenengrafts. Zeitschrift für Herz-,Thorax- und Gefäßchirurgie
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D. Mukherjee, H. Ashrafian, A. Kourliouros, K. Ahmed, A. Darzi, T. Athanasiou. (2012) Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis. European Journal of Cardio-Thoracic Surgery 41:2, 291-299
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Eric J. Velazquez, Judson B. Williams, Eric Yow, Linda K. Shaw, Kerry L. Lee, Harry R. Phillips, Christopher M. O'Connor, Peter K. Smith, Robert H. Jones. (2012) Long-Term Survival of Patients With Ischemic Cardiomyopathy Treated by Coronary Artery Bypass Grafting Versus Medical Therapy. The Annals of Thoracic Surgery 93:2, 523-530
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Joanne Shannon, Antonio Colombo. (2012) Revascularization in multivessel CAD: a functional approach. Nature Reviews Cardiology
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Marco Roffi, Flavio Ribichini, Fausto Castriota, Alberto Cremonesi. (2012) Management of Combined Severe Carotid and Coronary Artery Disease. Current Cardiology Reports
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Selnes, Ola A., Gottesman, Rebecca F., Grega, Maura A., Baumgartner, William A., Zeger, Scott L., McKhann, Guy M., . (2012) Cognitive and Neurologic Outcomes after Coronary-Artery Bypass Surgery. New England Journal of Medicine 366:3, 250-257
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G. Hossein Almassi, Sharon A. Pecsi, Joseph F. Collins, A. Laurie Shroyer, Marco A. Zenati, Frederick L. Grover. (2012) Predictors and impact of postoperative atrial fibrillation on patients’ outcomes: A report from the Randomized On Versus Off Bypass trial. The Journal of Thoracic and Cardiovascular Surgery 143:1, 93-102
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James E. Cottrell, John Hartung. (2012) Developmental Disability in the Young and Postoperative Cognitive Dysfunction in the Elderly After Anesthesia and Surgery: Do Data Justify Changing Clinical Practice?. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 79:1, 75-94
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Hui-Li Gan, Jian-Qun Zhang, Wei Xiao, Shuang Zhao, Fang-jong Huang, Cheng-xiong Gu, Chun-shang Lu, Pi-Shan Wang. (2012) Ostial left main coronary artery stenosis as an additional risk factor in off-pump coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 143:1, 103-110
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Elsayed Elmistekawy, Vincent Chan, Michael E. Bourke, Jean-Yves Dupuis, Fraser D. Rubens, Thierry G. Mesana, Marc Ruel. (2012) Off-pump coronary artery bypass grafting does not preserve renal function better than on-pump coronary artery bypass grafting: Results of a case-matched study. The Journal of Thoracic and Cardiovascular Surgery 143:1, 85-92
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J. James Edelman, Tristan D. Yan, Michael P. Vallely. (2012) Anaortic off-pump coronary artery bypass grafting: The criterion standard for minimization of neurologic injury. The Journal of Thoracic and Cardiovascular Surgery 143:1, 251-252
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Soroosh Kiani, Pranjal H. Desai, Nannan Thirumvalavan, Dinesh John Kurian, Mary Margaret Flynn, XiaoQing Zhao, Robert S. Poston. (2012) Endoscopic Venous Harvesting by Inexperienced Operators Compromises Venous Graft Remodeling. The Annals of Thoracic Surgery 93:1, 11-18
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Maximilian Y. Emmert, Sacha P. Salzberg, Volkmar Falk. (2012) Reply to the Editor. The Journal of Thoracic and Cardiovascular Surgery 143:1, 252
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Andre Lamy, Philip J. Devereaux, Dorairaj Prabhakaran, Shengshou Hu, Leopoldo S. Piegas, Zbynek Straka, Ernesto Paolasso, David Taggart, Fernando Lanas, A. Ruchan Akar, Anil Jain, Nicolas Noiseux, Yongning Ou, Susan Chrolavicius, Jennifer Ng, Salim Yusuf. (2012) Rationale and design of The Coronary Artery Bypass Grafting Surgery Off or On Pump Revascularization Study: A large international randomized trial in cardiac surgery. American Heart Journal 163:1, 1-6
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M. Carnero-Alcazar, A. Alswies, E. Villagran Medinilla, L. C. Maroto, J. A. Silva Guisasola, J. Cobiella Carnicer, M. T. Tejerina Sanchez, J. E. Rodriguez Hernandez. (2011) Mid-term outcomes after off-pump coronary surgery in patients with prior intracoronary stent. European Journal of Cardio-Thoracic Surgery
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2011. Can Research Guide Us to Improved Care at Lower Costs?. , 131-146.
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A. Diegeler. (2011) Koronare Bypassoperation ohne Einsatz der Herz-Lungen-Maschine. Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 25:6, 337-346
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L. David Hillis, Peter K. Smith, Jeffrey L. Anderson, John A. Bittl, Charles R. Bridges, John G. Byrne, Joaquin E. Cigarroa, Verdi J. DiSesa, Loren F. Hiratzka, Adolph M. Hutter, Michael E. Jessen, Ellen C. Keeley, Stephen J. Lahey, Richard A. Lange, Martin J. London, Michael J. Mack, Manesh R. Patel, John D. Puskas, Joseph F. Sabik, Ola Selnes, David M. Shahian, Jeffrey C. Trost, Michael D. Winniford. (2011) 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. Journal of the American College of Cardiology 58:24, e123-e210
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A. Thiem, T. Attmann, J. Cremer. (2011) Moderne Koronarchirurgie in Zusammenhang mit der SYNTAX-Studie und aktuellen Leitlinien. Herz 36:8, 669-676
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Tabitha South. (2011) Coronary Artery Bypass Surgery. Critical Care Nursing Clinics of North America 23:4, 573-585
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George Hahalis, George Dangas, Periklis Davlouros, Dimitrios Alexopoulos. (2011) Revascularization strategies for stable multivessel and unprotected left main coronary artery disease: From BARI to SYNTAX. International Journal of Cardiology 153:2, 126-134
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Gerhard Wimmer-Greinecker, Olivier Bouchot, Jean P. Verhoye, Louis P. Perrault, Jochen Börgermann, Anno Diegeler, Leen Van Garsse, Ardawan J. Rastan. (2011) Randomized Clinical Trial Comparing a Thermosensitive Polymer (LeGoo) With Conventional Vessel Loops for Temporary Coronary Artery Occlusion During Off-Pump Coronary Artery Bypass Surgery. The Annals of Thoracic Surgery 92:6, 2177-2183
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Massimo G. Lemma, Enrico Coscioni, Francesco P. Tritto, Paolo Centofanti, Corrado Fondacone, Andrea Salica, Agnese Rossi, Tiziana De Santo, Giuseppe Di Benedetto, Luigi Piazza, Mauro Rinaldi, Antonio L. De Luca Tupputi Schinosa, Ruggero De Paulis, Monica Contino, Michele Genoni. (2011) On-pump versus off-pump coronary artery bypass surgery in high-risk patients: Operative results of a prospective randomized trial (on-off study). The Journal of Thoracic and Cardiovascular Surgery
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Dimitri Novitzky, Janet H. Baltz, Brack Hattler, Joseph F. Collins, Elizabeth Kozora, A. Laurie Shroyer, Frederick L. Grover. (2011) Outcomes After Conversion in the Veterans Affairs Randomized On Versus Off Bypass Trial. The Annals of Thoracic Surgery 92:6, 2147-2154
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Takeshi Kinoshita, Tohru Asai, Tomoaki Suzuki, Satoshi Kuroyanagi, Soh Hosoba, Noriyuki Takashima. (2011) Off-pump Bilateral Skeletonized Internal Thoracic Artery Grafting in Elderly Patients. The Annals of Thoracic Surgery
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M. Guerra, J. C. Mota. (2011) Impact of incomplete surgical revascularization on survival. Interactive CardioVascular and Thoracic Surgery
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S. Urso, J. R. Sadaba, M. Pettinari. (2011) Impact of off-pump to on-pump conversion rate on post-operative results in patients undergoing off-pump coronary artery bypass. Interactive CardioVascular and Thoracic Surgery
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Hiroki Wakamatsu, Toshiki Watanabe, Yoshiyuki Sato, Shinya Takase, Sadao Omata, Hitoshi Yokoyama. (2011) Landiolol reduces coronary artery motion in an open-chest porcine model: implications for off-pump coronary artery bypass surgery. Surgery Today
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D. P. Taggart, D. G. Altman. (2011) Off-pump vs. on-pump CABG: are we any closer to a resolution?. European Heart Journal
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Sridhar Venkatachalam, Mehdi H. Shishehbor. (2011) Management of carotid disease in patients undergoing coronary artery bypass surgery. Current Opinion in Cardiology 26:6, 480-487
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Kyriakos Anastasiadis, Polychronis Antonitsis, Christos Papakonstantinou. (2011) When Is the Optimal Time to Perform Neurocognitive Assessment After Coronary Artery Bypass Surgery?. The Annals of Thoracic Surgery 92:5, 1933
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Omar A. Jarral, Srdjan Saso, Thanos Athanasiou. (2011) Off-Pump Coronary Artery Bypass in Patients With Left Ventricular Dysfunction: A Meta-Analysis. The Annals of Thoracic Surgery 92:5, 1686-1694
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Robert A. Henderson, Adam D. Timmis. (2011) Almanac 2011: stable coronary artery disease. The national society journals present selected research that has driven recent advances in clinical cardiology. Revista Portuguesa de Cardiologia 30:11, 869-878
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Masaki Yamamoto, Shiro Sasaguri, Takayuki Sato. (2011) Assessing intraoperative blood flow in cardiovascular surgery. Surgery Today 41:11, 1467-1474
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Robert A. Henderson, Adam D. Timmis. (2011) Almanac 2011: Stable coronary artery disease. The national society journals present selected research that has driven recent advances in clinical cardiology. Revista Portuguesa de Cardiologia (English Edition) 30:11, 869-878
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J. Afilalo, M. Rasti, S. M. Ohayon, A. Shimony, M. J. Eisenberg. (2011) Off-pump vs. on-pump coronary artery bypass surgery: an updated meta-analysis and meta-regression of randomized trials. European Heart Journal
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Maximilian Y. Emmert, Sacha P. Salzberg, Burkhardt Seifert, Ulrich P. Schurr, Oliver M. Theusinger, Simon P. Hoerstrup, Oliver Reuthebuch, Michele Genoni. (2011) Off-Pump Surgery Is Not a Contraindication for Patients with a Severely Decreased Ejection Fraction. The Heart Surgery Forum 14:5, E302-E306
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Marie-Claude Morice, Ted E. Feldman, Michael Mack, Elisabeth Ståhle, David Holmes, Antonio Colombo, Marie-Angèle Morel, Marcel van den Brand, Patrick Serruys, Friedrich Mohr, Didier Carrié, Gérard Fournial, Stefan James, Katrin Leadley, Keith Dawkins, A. Pieter Kappetein. (2011) Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery: fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS). EuroIntervention 7:6, 670-679
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Y.-T. Tsai, F.-Y. Lin, C.-H. Lai, Y.-C. Lin, C.-Y. Lin, C.-S. Tsai. (2011) On-pump beating-heart coronary artery bypass provides efficacious short- and long-term outcomes in hemodialysis patients. Nephrology Dialysis Transplantation
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Marco A. Zenati, A. Laurie Shroyer. (2011) Reply to the Editor. The Journal of Thoracic and Cardiovascular Surgery 142:3, 725
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Manuel Carnero-Alcázar, Luis C. Maroto Castellanos, Jacobo A. Silva Guisasola, Javier Cobiella Carnicer, Ali Alswies, Manuel E. Fuentes Ferrer, José E. Rodríguez Hernández. (2011) SYNTAX Score is associated with worse outcomes after off-pump coronary artery bypass grafting surgery for three-vessel or left main complex coronary disease. The Journal of Thoracic and Cardiovascular Surgery 142:3, e123-e132
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Umberto Benedetto, Giovanni Melina, Emiliano Angeloni, Riccardo Sinatra. (2011) If we are uncritical, we shall always find what we want. The Journal of Thoracic and Cardiovascular Surgery 142:3, 723-724
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Maral Ouzounian, Imtiaz S. Ali. (2011) Endoscopic versus open saphenous vein harvest technique in the Randomized On/Off Bypass (ROOBY) Trial. The Journal of Thoracic and Cardiovascular Surgery 142:3, 724-725
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Ralph J. Damiano. (2011) Surgical Innovation in the Information Age. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 6:5, 283-288
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Shahzad G. Raja, Mohamed Amrani. (2011) Evidence for efficacy of off-pump coronary artery bypass surgery: Facts and fads. The Journal of Thoracic and Cardiovascular Surgery 142:3, 723
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Michael S. Lee, Seung-Jung Park, David E. Kandzari, Ajay J. Kirtane, William F. Fearon, Emmanouil S. Brilakis, Paul Vermeersch, Young-Hak Kim, Ron Waksman, Julinda Mehilli, Laura Mauri, Gregg W. Stone. (2011) Saphenous Vein Graft Intervention. JACC: Cardiovascular Interventions 4:8, 831-843
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Yanai Ben-Gal, Gregg W. Stone, Craig R. Smith, Mathew R. Williams, Giora Weisz, Allan S. Stewart, Hiroo Takayama, Philippe Genereux, Michael Argenziano. (2011) On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. The Journal of Thoracic and Cardiovascular Surgery 142:2, e33-e39
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Marco A. Zenati. (2011) Reply to the Editor. The Journal of Thoracic and Cardiovascular Surgery 142:2, 481-482
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Giovanni Filardo, Paul A. Grayburn, Cody Hamilton, Robert F. Hebeler, William B. Cooksey, Baron Hamman. (2011) Comparing Long-Term Survival Between Patients Undergoing Off-Pump and On-Pump Coronary Artery Bypass Graft Operations. The Annals of Thoracic Surgery 92:2, 571-578
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Matthias Siepe, Thomas Pfeiffer, Andreas Gieringer, Silke Zemann, Christoph Benk, Christian Schlensak, Friedhelm Beyersdorf. (2011) Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium. European Journal of Cardio-Thoracic Surgery 40:1, 200-207
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George V. Letsou, Ying Xing Wu, Gary Grunkemeier, Murtuza M. Rampurwala, Larry Kaiser, Abhijit L. Salaskar. (2011) Off-pump coronary artery bypass and avoidance of hypothermic cardiac arrest improves early left ventricular function in patients with systolic dysfunction. European Journal of Cardio-Thoracic Surgery 40:1, 227-232
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C. F. Royse, D. T. Andrews, S. N. Newman, J. Stygall, Z. Williams, J. Pang, A. G. Royse. (2011) The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery*. Anaesthesia 66:6, 455-464
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John D. Puskas, Willis H. Williams, Robert O'Donnell, Randolph E. Patterson, Steven R. Sigman, A. Shannon Smith, Kim T. Baio, Patrick D. Kilgo, Robert A. Guyton. (2011) Off-Pump and On-Pump Coronary Artery Bypass Grafting Are Associated With Similar Graft Patency, Myocardial Ischemia, and Freedom From Reintervention: Long-Term Follow-Up of a Randomized Trial. The Annals of Thoracic Surgery 91:6, 1836-1843
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Akira Marui, Takeshi Kimura, Shiro Tanaka, Yutaka Furukawa, Toru Kita, Ryuzo Sakata. (2011) Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: a propensity score analysis. European Journal of Cardio-Thoracic Surgery
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Zanxin Wang, Fei Gao, Jianlong Men, Jing Ren, Paul Modi, Minxin Wei. (2011) Aspirin resistance in off-pump coronary artery bypass grafting. European Journal of Cardio-Thoracic Surgery
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Maximilian Y. Emmert, Sacha P. Salzberg, Oliver M. Theusinger, Hector Rodriguez, Simon H. Sündermann, Andre Plass, Christoph T. Starck, Burkhardt Seifert, Werner Baulig, Simon P. Hoerstrup, Stephan Jacobs, Jürg Grünenfelder, Volkmar Falk. (2011) Off-pump surgery for the poor ventricle?. Heart and Vessels
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Danny Chu, David H. Berger, Faisal G. Bakaeen. (2011) Comparing the Quality of Surgical Care: A Reason for Caution. Journal of the American College of Surgeons 212:5, 907-908
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J. James Edelman, Tristan D. Yan, Paul G. Bannon, Michael K. Wilson, Michael P. Vallely. (2011) Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta – A Meta-Analysis. Heart, Lung and Circulation 20:5, 318-324
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Seshasayee Narasimhan, Vankeepuram S. Srinivas, Joseph John DeRose. (2011) Hybrid Coronary Revascularization. Cardiology in Review 19:3, 101-107
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Hisato Takagi, Masafumi Matsui, Takuya Umemoto. (2011) Conventional rather than off-pump coronary artery bypass grafting should be performed for non–high-risk patients. The Journal of Thoracic and Cardiovascular Surgery 141:5, 1330-1331
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Eivind Øvrum, Geir Tangen, Stein Tølløfsrud, Bjørn Skeie, Mari Anne L. Ringdal, Reidar Istad, Rolf Øystese. (2011) Heparinized cardiopulmonary bypass circuits and low systemic anticoagulation: An analysis of nearly 6000 patients undergoing coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 141:5, 1145-1149
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Faisal G. Bakaeen, Elizabeth H. Stephens, Danny Chu, William L. Holman, Ara A. Vaporciyan, Walter H. Merrill, Frederick L. Grover. (2011) Perceptions regarding cardiothoracic surgical training at Veterans Affairs hospitals. The Journal of Thoracic and Cardiovascular Surgery 141:5, 1107-1113
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Nishith N. Patel, Gianni D. Angelini. (2011) Reply to the Editor. The Journal of Thoracic and Cardiovascular Surgery 141:5, 1331-1332.e1
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Ciarán O. McDonnell, Caroline C. Herron, John P. Hurley, James F. McCarthy, Lars Nolke, J. Mark Redmond, Alfred E. Wood, Martin K. O’Donohoe, M. Kevin O’ Malley. (2011) Importance of strict patient selection criteria for combined carotid endarterectomy and coronary artery bypass grafting. The Surgeon
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Kevin W. Hatton, Jeremy D. Flynn, Christine Lallos, Brenda G. Fahy. (2011) Integrating Evidence-Based Medicine Into the Perioperative Care of Cardiac Surgery Patients. Journal of Cardiothoracic and Vascular Anesthesia 25:2, 335-346
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Takeshi Kinoshita, Tohru Asai. (2011) Bilateral Internal Thoracic Artery Grafting. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 6:2, 77-83
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Ramy F. Ayad, Paul S. Bhella, William D. Dockery, Jeffrey M. Schussler. (2011) Patency of Vein Graft Anastomoses Facilitated With the Hexalon Device. The Annals of Thoracic Surgery 91:3, 894-898
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Victor A. Ferraris, Jeremiah R. Brown, George J. Despotis, John W. Hammon, T. Brett Reece, Sibu P. Saha, Howard K. Song, Ellen R. Clough, Linda J. Shore-Lesserson, Lawrence T. Goodnough, C. David Mazer, Aryeh Shander, Mark Stafford-Smith, Jonathan Waters, Robert A. Baker, Timothy A. Dickinson, Daniel J. FitzGerald, Donald S. Likosky, Kenneth G. Shann. (2011) 2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines
The International Consortium for Evidence Based Perfusion formally endorses these guidelines.. The Annals of Thoracic Surgery 91:3, 944-982
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Eric L. Sarin, Michael O. Kayatta, Patrick Kilgo, Ameesh Dara, John D. Puskas, Omar M. Lattouf, Edward P. Chen, Michael E. Halkos, Robert A. Guyton, Vinod H. Thourani. (2011) Short- and Long-Term Outcomes in Octogenarian Patients Undergoing Off-Pump Coronary Artery Bypass Grafting Compared With On-Pump Coronary Artery Bypass Grafting. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 6:2, 110-115
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David H. Adams, Joanna Chikwe, Farzan Filsoufi, Anelechi C. Anyanwu. (2011) The Year in Cardiovascular Surgery. Journal of the American College of Cardiology 57:13, 1425-1444
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J. Cremer. (2011) OPCAB-Revaskularisation. Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 25:1, 13-14
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Tracy Y. Wang, Antonio Gutierrez, Eric D. Peterson. (2011) Percutaneous coronary intervention in the elderly. Nature Reviews Cardiology 8:2, 79-90
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A. Diegeler. (2011) Koronare Bypasschirurgie ohne Einsatz der Herz-Lungen-Maschine. Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 25:1, 15-18
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Marco A. Zenati, A. Laurie Shroyer, Joseph F. Collins, Brack Hattler, Takeyoshi Ota, G. Hossein Almassi, Morteza Amidi, Dimitri Novitzky, Frederick L. Grover, Ali F. Sonel. (2011) Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial. The Journal of Thoracic and Cardiovascular Surgery 141:2, 338-344
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Deepak K. Tempe, Devesh Dutta, Mukesh Garg, Harpreet Minhas, Akhlesh Tomar, Sanjula Virmani. (2011) Myocardial Protection with Isoflurane During Off-Pump Coronary Artery Bypass Grafting: A Randomized Trial. Journal of Cardiothoracic and Vascular Anesthesia 25:1, 59-65
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A. Liebold. (2011) Stellenwert der minimierten extrakorporalen Zirkulation in der modernen Koronarchirurgie. Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 25:1, 19-20
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Shengshou Hu, Qi Li, Peixian Gao, Hui Xiong, Zhe Zheng, Lihuan Li, Bo Xu, Runlin Gao. (2011) Simultaneous Hybrid Revascularization Versus Off-Pump Coronary Artery Bypass for Multivessel Coronary Artery Disease. The Annals of Thoracic Surgery 91:2, 432-438
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Dayal Mukherjee, Kamran Ahmed, Kamran Baig, Vanash M. Patel, Ara Darzi, Thanos Athanasiou. (2011) Conversion and Safety in Off-Pump Coronary Artery Bypass: A System Failure That Needs Re-Emphasis. The Annals of Thoracic Surgery 91:2, 630-639
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Julie Huffmyer, Jacob Raphael. (2011) The current status of off-pump coronary bypass surgery. Current Opinion in Anaesthesiology 24:1, 64-69
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H El-Abd, S Salah. (2011) A nonrandomized comparison of off -pump versus on-pump coronary bypass surgery in Egyptian patients. Critical Care 15:Suppl 1, P10
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Damien J. LaPar, Castigliano M. Bhamidipati, T. Brett Reece, Joseph C. Cleveland, Irving L. Kron, Gorav Ailawadi. (2011) Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?. The Journal of Thoracic and Cardiovascular Surgery 141:1, 81-90
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S. BREITER. 2011. Membranes for oxygenators and plasma filters. , 3-33.
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Katherine Swartz. (2010) Challenges in an aging society: Presidential address to APPAM. Journal of Policy Analysis and Management 29:2, 227-242
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Nishith N. Patel, Gianni D. Angelini. (2010) Off-pump coronary artery bypass grafting: For the many or the few?. The Journal of Thoracic and Cardiovascular Surgery 140:5, 951-953.e1
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Michael E Halkos, John D Puskas. (2010) Off-pump coronary surgery: where do we stand in 2010?. Current Opinion in Cardiology 25:6, 583-588
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M. Sousa Uva, S. Cavaco, A. G. Oliveira, F. Matias, C. Silva, A. Mesquita, P. Aguiar, J. Bau, A. Pedro, M. P. Magalhaes. (2010) Early graft patency after off-pump and on-pump coronary bypass surgery: a prospective randomized study. European Heart Journal 31:20, 2492-2499
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F.-W. Mohr. (2010) To beat or not to beat? From one size fits it all to an individual coronary revascularization strategy. European Heart Journal 31:20, 2441-2443
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, , W. Wijns, P. Kolh, N. Danchin, C. Di Mario, V. Falk, T. Folliguet, S. Garg, K. Huber, S. James, J. Knuuti, J. Lopez-Sendon, J. Marco, L. Menicanti, M. Ostojic, M. F. Piepoli, C. Pirlet, J. L. Pomar, N. Reifart, F. L. Ribichini, M. J. Schalij, P. Sergeant, P. W. Serruys, S. Silber, M. Sousa Uva, D. Taggart, , A. Vahanian, A. Auricchio, J. Bax, C. Ceconi, V. Dean, G. Filippatos, C. Funck-Brentano, R. Hobbs, P. Kearney, T. McDonagh, B. A. Popescu, Z. Reiner, U. Sechtem, P. A. Sirnes, M. Tendera, P. E. Vardas, P. Widimsky, , P. Kolh, O. Alfieri, J. Dunning, S. Elia, P. Kappetein, U. Lockowandt, G. Sarris, P. Vouhe, , P. Kearney, L. von Segesser, S. Agewall, A. Aladashvili, D. Alexopoulos, M. J. Antunes, E. Atalar, A. Brutel de la Riviere, A. Doganov, J. Eha, J. Fajadet, R. Ferreira, J. Garot, J. Halcox, Y. Hasin, S. Janssens, K. Kervinen, G. Laufer, V. Legrand, S. A. M. Nashef, F.-J. Neumann, K. Niemela, P. Nihoyannopoulos, M. Noc, J. J. Piek, J. Pirk, Y. Rozenman, M. Sabate, R. Starc, M. Thielmann, D. J. Wheatley, S. Windecker, M. Zembala. (2010) Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal 31:20, 2501-2555
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Frances O. Wood, Neeraj Badhey, Bobby Garcia, Abdul-rahman Abdel-karim, Brij Maini, Subhash Banerjee, Emmanouil S. Brilakis. (2010) Analysis of saphenous vein graft lesion composition using near-infrared spectroscopy and intravascular ultrasonography with virtual histology. Atherosclerosis 212:2, 528-533
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Elizabeth Kozora, Susan Kongs, Joseph F. Collins, Brack Hattler, Janet Baltz, Michael Hampton, Frederick L. Grover, Dimitri Novitzky, A. Laurie Shroyer. (2010) Cognitive Outcomes After On- Versus Off-Pump Coronary Artery Bypass Surgery. The Annals of Thoracic Surgery 90:4, 1134-1141
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Timothy J. Gardner. (2010) Are randomized trials the best way to judge the efficacy of surgical procedures?. The Journal of Thoracic and Cardiovascular Surgery 140:4, 739-742
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Yanai Ben-Gal, Jeffrey W. Moses, Roxana Mehran, Alexandra J. Lansky, Giora Weisz, Eugenia Nikolsky, Michael Argenziano, Matthew R. Williams, Antonio Colombo, Philip E. Aylward, Gregg W. Stone. (2010) Surgical Versus Percutaneous Revascularization for Multivessel Disease in Patients With Acute Coronary Syndromes. JACC: Cardiovascular Interventions 3:10, 1059-1067
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Maria Alexandra Rodriguez, David L Fischman, Michael P Savage. (2010) Advances in vein graft intervention. Interventional Cardiology 2:5, 735-754
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Tristan D. Yan, Michael P. Vallely. (2010) Aortic No-Touch Off-Pump Coronary Artery Bypass Grafting: A State-of-the-Art Surgical Technique. The Annals of Thoracic Surgery 90:4, 1392-1393
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Charuhas V. Thakar. (2010) Predicting Acute Kidney Injury After Cardiac Surgery: How to Use the “Crystal Ball”. American Journal of Kidney Diseases 56:4, 605-608
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John M. Alvarez. (2010) Critical evaluation: OPCAB surgery - the road to hell is paved with good intentions. ANZ Journal of Surgery 80:10, 748-749
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J. James Edelman, Tristan D. Yan, Ratnasari Padang, Paul G. Bannon, Michael P. Vallely. (2010) Off-Pump Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention: A Meta-Analysis of Randomized and Nonrandomized Studies. The Annals of Thoracic Surgery 90:4, 1384-1390
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Sara C. Arrigoni, Gianclaudio Mecozzi, Felix Zijlstra, Massimo A. Mariani. (2010) Reply. The Annals of Thoracic Surgery 90:4, 1393-1394
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Michael S. Lauer. (2010) The historical and moral imperatives of comparative effectiveness research. Statistics in Medicine 29:19, 1982-1984
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Ardawan Julian Rastan, Holger Thiele, Gerhard Schuler, Friedrich Wilhelm Mohr. (2010) Stellenwert der koronaren Bypass operation in der Therapie der akuten Koronarsyndrome. Herz 35:2, 70-78
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Linda Shore-Lesserson. (2010) Invited Commentary. The Annals of Thoracic Surgery 89:2, 427-428
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Tadateru Takayama, Takafumi Hiro, Atsushi Hirayama. (2010) Is Angioplasty Able to Become the Gold Standard of Treatment Beyond Bypass Surgery for Patients With Multivessel Coronary Artery Disease?. Circulation Journal 74:12, 2744-2749
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