Causes and implications of emergency conversion on on-pump during coronary artery bypass grafting in patients with ischemic heart disease

  • A. V. Rudenko National M. M. Amosov Institute of Cardiovascular Surgery National Academy of Medical Sciences of Ukraine (Kyiv)
  • O. O. Zhurba National M. M. Amosov Institute of Cardiovascular Surgery National Academy of Medical Sciences of Ukraine (Kyiv)
Keywords: coronary bypass, OPCABG, ONCABG, emergency conversion, immediate results, intraoperative complications


Emergency conversion on-pump during OPCABG significantly impairs the immediate results of myocardial revascularization.

The purpose of this study was to review the causes and consequences of these cases based on the results of a retrospective analysis of 4,668 patients. It was established that in patients with the use of on-pump surgery, there is a significant increase of the frequency of all postoperative complications, and in case of emergency conversion postoperative lethality is increasing too. The reasons for emergency conversion were hemodynamic instability, elevation of the ST segment, and rhythm disturbances. These intraoperative complications were manifested in other patients, but they were eliminated without the use of on-pump surgery. We believe that the complications during the operation have similar provocative factors that should be taken into account when determining the predictors of their development.


1. Гандзюк В. А. Аналіз захворюваності на ішемічну хворобу серця в Україні / В. А. Гандзюк // Український кардіологічний журнал. – 2014. – № 3. – С. 45–52.

2. Коронарное шунтирование у пожилых пациентов / Тунгусов Д. С., Чернов И. И., Уртаев Р. А. [и др.] // Анналы хирургии. – 2012. – № 2. – С. 51–56.

3. Руденко А. В., Урсуленко В. И., Купчинский А. В. 10 тысяч операций коронарного шунтирования на работающем сердце (опыт одной клиники) // Вісник серцево-судинної хірургії – 2016. – Вип. 1.

4. Теренда Н. О. Основні тенденції та прогнозні оцінки загальної та первинної захворюваності на ішемічну хворобу серця в Україні / Н. О. Теренда // Вісник соціальної гігієни та організації охорони здоров’я України. – 2016. – № 3 (69). – С. 31–35.

5. 2014 ESC EACTS Guidelines on myocardial revascular-ization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the Eu-ropean Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) / Windecker S., Kolh P., Alfonso F. et al. // Eu-ropean Heart Journal. – 2014. – Vol. 35. – P. 2541–2619.

6. Analysis of Risk Factors for Conversion from Off-Pump to On-Pump Coronary Artery Bypass Graft / J. Lim, W. Y. Lee, Y. J. Ra [et al.] // Korean J ThoracCardiovasc Surg. – 2017. – Vol. 50. – P. 14–21.

7. Beneficial effects of ischemic preconditioning on right ventricular function after coronary artery bypass grafting / Z. K. Wu, M. R. Tarkka, E. Pehkonen [et al.] // Ann. Tho-rac. Surg. – 2000. – Vol. 70. – P. 155–157.

8. Clinical validation of coronary artery flow through an in-tracoronary shunt during off-pump coronary artery bypass grafting / Y. Takami, K. Tajima, W. Kato [et al.] // J Tho-racCardiovasc Surg. – 2014. – Vol. 147 (1). – P. 259–263.

9. Conversion and safety in off-pump coronary artery bypass: a system failure that needs re-emphasis / Mukherjee D., Ahmed K., Baig K. [et al.] // Ann. Thorac. Surg. – 2011. – Vol. 91. – P. 630–639.

10. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Bur-den of Disease Study 2015 // Lancet. – 2016. – Vol. 388. – P. 1459–1544.

11. Legare J.-F., Buth K. J., Hirsch G. M. Conversion to on pump from OPCAB is associated with increased mortal-ity: results from a randomized controlled trial // European Journal of Cardio-thoracic Surgery. – 2005. – Vol. 27. – P. 296–301.

12. Managament of conversions to cardiopulmonary bypass in beating heart coronary surgery / E. Mujanovic, J. 2 Bergsland, S. Stanimirovic-Mujanovic 2 , E. 2 Kabil // Bosnian journal of basic medical sciences. – 2008. – Vol. 8 (3). – P. 266–269.

13. Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery / Reeves B. C., Ascion e R., Caputo M. [et al.] // Eur J Cardiothorac Surg. – 2006 Jun. – Vol. 29 (6). – P. 941–7.

14. Outcomes after conversion in the Veterans Affairs random-ized on versus off bypass trial / Novitzky D., Baltz J. H., Hattler B. [et al.] // Ann Thorac Surg. – 2011. – Vol. 92. – P. 2147–2154.

15. Predictors of emergency conversion to on-pump during off-pump coronary surgery / A. Hovakimyan, V. Manukyan, S. Ghazaryan [et al.] // Asian CardiovascThorac Ann. – 2008. – Vol. 16. – P. 226–230.
How to Cite
Rudenko, A. V., & Zhurba, O. O. (2018). Causes and implications of emergency conversion on on-pump during coronary artery bypass grafting in patients with ischemic heart disease. Ukrainian Journal of Cardiovascular Surgery, (2 (31), 22-26.

Most read articles by the same author(s)