Dayal Mukherjee, MBBS, Kamran Ahmed, MRCS, Kamran Baig, MRCS, Vanash M

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Conversion and Safety in Off-Pump Coronary Artery Bypass: A System Failure That Needs Re-Emphasis Dayal Mukherjee, MBBS, Kamran Ahmed, MRCS, Kamran Baig, MRCS, Vanash M. Patel, MS, MRCS, Ara Darzi, FRCS, KBE, Thanos Athanasiou, PhD, FETCS The Annals of Thoracic Surgery Volume 91, Issue 2, Pages 630-639 (February 2011) DOI: 10.1016/j.athoracsur.2010.10.031 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Causes of overall conversion (emergency and elective) in the literature [10–12], [14–22]. The Annals of Thoracic Surgery 2011 91, 630-639DOI: (10.1016/j.athoracsur.2010.10.031) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Schematic diagram illustrating the relationship between the predictors and consequences of conversion, the potential interventional role of preventative strategies. (B) Potential prevention strategies of emergency conversion. (CCS class = Canadian Cardiovascular Society; COPD = chronic obstructive pulmonary disease; CPB = cardiopulmonary bypass; IAPBs = intra-aortic pulmonary bypasses; MI = myocardial infarction; OPCAB = off-pump coronary artery bypass; Pre-op = preoperative; TTE = transthoracic echocardiogram; VADs = ventricular assist devices.) The Annals of Thoracic Surgery 2011 91, 630-639DOI: (10.1016/j.athoracsur.2010.10.031) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 A flow diagram representing the decisional process from preoperative evaluation to successful OPCAB. Stratified according to decision levels 1 to 3, with the higher the decision level, the later the decision occurs, and the more imminent the risk of emergency conversion. (ITT = intention-to-treat; OPCAB = off-pump coronary artery bypass; ONCAB = on-pump coronary artery bypass.) The Annals of Thoracic Surgery 2011 91, 630-639DOI: (10.1016/j.athoracsur.2010.10.031) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Graph demonstrating a reducing trend in conversion mortality with an increasing number of off-pump coronary artery bypass (OPCAB) safety measures (see Table 4). The Annals of Thoracic Surgery 2011 91, 630-639DOI: (10.1016/j.athoracsur.2010.10.031) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions