Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer?

Donald S. Likosky, Robert A. Baker, Richard F. Newland, Theron A. Paugh, Timothy A. Dickinson, David Fitzgerald, Joshua B. Goldberg, Nicholas B. Mellas, Alan F. Merry, Paul S. Myles, Gaetano Paone, Kenneth G. Shann, Jane Ottens, Timothy W. Willcox, International Consortium for Evidence-Based Perfusion, the PERForm Registry, the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as "conventional," inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015. Variation in equipment and management practices reflecting key areas of CPB is described across 47 centers (ANZCPR: 9; PERForm: 38). We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100%), as were "all-but-cannula" biopassive surface coatings (>90%), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85% vs. PERForm: 64%). ANZCPR participants had 640 mL absolute higher net prime volumes, attributed in part to higher total prime volume (1,462 mL vs. 1,217 mL) and lower adoption of retrograde autologous priming (20% vs. 81%). ANZCPR participants had higher nadir hematocrit on CPB (27 vs. 25). Minimal absolute differences existed in exposure to high arterial outflow temperatures (36.6°C vs. 37.0°C). We report substantial center and registry differences in both the type of equipment used and CPB management strategies. These findings suggest that the term "conventional bypass" may not adequately reflect real-world experiences. Instead of using this term, authors should provide key details of the CPB practices used in their patients.

Original languageEnglish
Pages (from-to)225-230
Number of pages6
JournalJournal of Extra-Corporeal Technology
Volume50
Issue number4
Publication statusPublished - 1 Dec 2018

Keywords

  • cardiopulmonary bypass (CPB)
  • collaborative; perfusion
  • equipment; registry

Cite this

Likosky, D. S., Baker, R. A., Newland, R. F., Paugh, T. A., Dickinson, T. A., Fitzgerald, D., ... International Consortium for Evidence-Based Perfusion, the PERForm Registry, the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (2018). Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer? Journal of Extra-Corporeal Technology, 50(4), 225-230.
Likosky, Donald S. ; Baker, Robert A. ; Newland, Richard F. ; Paugh, Theron A. ; Dickinson, Timothy A. ; Fitzgerald, David ; Goldberg, Joshua B. ; Mellas, Nicholas B. ; Merry, Alan F. ; Myles, Paul S. ; Paone, Gaetano ; Shann, Kenneth G. ; Ottens, Jane ; Willcox, Timothy W. ; International Consortium for Evidence-Based Perfusion, the PERForm Registry, the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. / Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer?. In: Journal of Extra-Corporeal Technology. 2018 ; Vol. 50, No. 4. pp. 225-230.
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abstract = "Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as {"}conventional,{"} inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015. Variation in equipment and management practices reflecting key areas of CPB is described across 47 centers (ANZCPR: 9; PERForm: 38). We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100{\%}), as were {"}all-but-cannula{"} biopassive surface coatings (>90{\%}), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85{\%} vs. PERForm: 64{\%}). ANZCPR participants had 640 mL absolute higher net prime volumes, attributed in part to higher total prime volume (1,462 mL vs. 1,217 mL) and lower adoption of retrograde autologous priming (20{\%} vs. 81{\%}). ANZCPR participants had higher nadir hematocrit on CPB (27 vs. 25). Minimal absolute differences existed in exposure to high arterial outflow temperatures (36.6°C vs. 37.0°C). We report substantial center and registry differences in both the type of equipment used and CPB management strategies. These findings suggest that the term {"}conventional bypass{"} may not adequately reflect real-world experiences. Instead of using this term, authors should provide key details of the CPB practices used in their patients.",
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Likosky, DS, Baker, RA, Newland, RF, Paugh, TA, Dickinson, TA, Fitzgerald, D, Goldberg, JB, Mellas, NB, Merry, AF, Myles, PS, Paone, G, Shann, KG, Ottens, J, Willcox, TW & International Consortium for Evidence-Based Perfusion, the PERForm Registry, the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative 2018, 'Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer?' Journal of Extra-Corporeal Technology, vol. 50, no. 4, pp. 225-230.

Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer? / Likosky, Donald S.; Baker, Robert A.; Newland, Richard F.; Paugh, Theron A.; Dickinson, Timothy A.; Fitzgerald, David; Goldberg, Joshua B.; Mellas, Nicholas B.; Merry, Alan F.; Myles, Paul S.; Paone, Gaetano; Shann, Kenneth G.; Ottens, Jane; Willcox, Timothy W.; International Consortium for Evidence-Based Perfusion, the PERForm Registry, the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative.

In: Journal of Extra-Corporeal Technology, Vol. 50, No. 4, 01.12.2018, p. 225-230.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Dickinson, Timothy A.

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AU - Goldberg, Joshua B.

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AU - Paone, Gaetano

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AU - Willcox, Timothy W.

AU - International Consortium for Evidence-Based Perfusion, the PERForm Registry, the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative

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N2 - Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as "conventional," inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015. Variation in equipment and management practices reflecting key areas of CPB is described across 47 centers (ANZCPR: 9; PERForm: 38). We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100%), as were "all-but-cannula" biopassive surface coatings (>90%), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85% vs. PERForm: 64%). ANZCPR participants had 640 mL absolute higher net prime volumes, attributed in part to higher total prime volume (1,462 mL vs. 1,217 mL) and lower adoption of retrograde autologous priming (20% vs. 81%). ANZCPR participants had higher nadir hematocrit on CPB (27 vs. 25). Minimal absolute differences existed in exposure to high arterial outflow temperatures (36.6°C vs. 37.0°C). We report substantial center and registry differences in both the type of equipment used and CPB management strategies. These findings suggest that the term "conventional bypass" may not adequately reflect real-world experiences. Instead of using this term, authors should provide key details of the CPB practices used in their patients.

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Likosky DS, Baker RA, Newland RF, Paugh TA, Dickinson TA, Fitzgerald D et al. Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer? Journal of Extra-Corporeal Technology. 2018 Dec 1;50(4):225-230.