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YEAR IN CARDIOLOGY SERIES: VIEWPOINT

Intraoperative Crossover: The Well-Kept Surgical Secret to Apparent Surgical Success

Department of Surgery/Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.

Manuscript received February 2, 2005; revised manuscript received February 24, 2005, accepted March 1, 2005.

^_* Reprint requests and correspondence: Dr. Robert H. Jones, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715. (Email: jones060{at}mc.duke.edu).

Cardiologists and patients contemplate the risk of proposed operations. Surgeons typically report outcomes on operations performed. Emergency intraoperative crossover from off- to on-pump coronary artery bypass grafting occurs uncommonly but has substantial rates of mortality and morbidity. Much of the reported perioperative benefit of off- compared with on-pump coronary artery bypass grafting is erased if data are presented by intention to treat and not by operation performed. Cardiologists and cardiac surgeons should share the responsibility for advising a patient to consent to a cardiac operation using honestly presented evidence of potential benefits and risks substantiated with information analyzed in patient-centric and not physician-centric ways.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   off-pump = off cardiopulmonary bypass coronary artery bypass grafting   on-pump = on cardiopulmonary bypass coronary artery bypass grafting

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