Comparison of Graft Patency Between Off-Pump and On-Pump Coronary Artery Bypass Grafting: An Updated Meta-Analysis

Zhang, Busheng; Zhou, Jingxin; Li, Haiqing; Liu, Zixiong; Chen, Anqing; Zhao, Qiang

doi:10.1016/j.athoracsur.2013.10.045

Cited by 73 publications

(50 citation statements)

References 24 publications

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“…Previous meta-analyses have found that OPCAB was associated with a significant increase in graft occlusion from both saphenous vein and arterial grafts, in addition to a decreased number of total grafts/patient. 7,8 However, in the current meta-analysis, although the number of grafts/patient was significantly decreased in the OPCAB patients, there was no difference in the need for repeat revascularization or the use of all arterial grafting between the groups. Furthermore, while the number of grafts was decreased in the OPCAB group, we are not told whether this was due to incomplete revascularization, or merely that there was a decrease in the number of distal targets that actually required grafting.…”

contrasting

confidence: 52%

On- versus off-pump coronary artery bypass-Another nail in the coffin?

Lazar

2018

J Card Surg

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contrasting

confidence: 52%

On- versus off-pump coronary artery bypass-Another nail in the coffin?

Lazar

2018

J Card Surg

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“…Off‐pump CABG has also been associated with a reduction in the length of ventilation and intensive care unit and hospital stay, less transfusion requirements, and less chest tube drainage . Despite these perioperative benefits, off‐pump CABG has been shown to increase the risk of graft occlusion and the need for repeat revascularization . Furthermore, there are data to suggest that off‐pump CABG may increase long‐term mortality .…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis of ≥5-year mortality in randomized controlled trials of off-pump versus on-pump coronary artery bypass grafting

et al. 2018

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Objectives We sought to determine whether off‐pump coronary artery bypass grafting (CABG) increases long‐term mortality, by performing a meta‐analysis of randomized controlled trials (RCTs) of off‐pump versus on‐pump CABG with ≥5‐year follow‐up. Methods MEDLINE and EMBASE, and the Cochrane Central Register of Controlled Trials were searched through July 2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of long‐term (≥5‐year) mortality for off‐pump versus on‐pump CABG were extracted from each individual trial. Study‐specific estimates were combined using inverse variance‐weighted averages of logarithmic HRs in the random‐effects model. Results Our search identified eight medium‐ to large‐size RCTs at low risk of bias with long‐term follow‐up of off‐pump versus on‐pump CABG enrolling a total of 8780 patients. Combining four RCTs reporting actual HRs generated a statistically significant result favoring on‐pump CABG (HR, 1.21; P = 0.02). A pooled analysis of all eight RCTs demonstrated a statistically significant increase in mortality with off‐pump CABG (HR/RR, 1.19; P = 0.01). There was no evidence of significant publication bias in the meta‐analysis of all eight RCTs. In a sensitivity analysis, extracting RRs or ORs from all eight RCTs and pooling them demonstrated a statistically significant increase in mortality with off‐pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007). Eliminating 2 RRs and combining six HRs still generated a statistically significant result favoring on‐pump CABG (HR, 1.19; P = 0.05). Conclusions Off‐pump CABG increases long‐term (≥5‐year) mortality compared with on‐pump CABG.

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“…The reduced graft patency, demonstrated in a meta-analysis of RCTs [53], seems consistent with data emerging from a meta-analysis of RCTs and observational studies in over 100 000 patients, which demonstrated a worse 5-year survival among off-as opposed to on-pump patients [54]. Interestingly, current evidence suggests that the difference in graft patency may be limited to SV grafts, suggesting a potential role for increased use of arterial conduits regardless of the CPB strategy employed.…”

Section: On-versus Off-pumpmentioning

confidence: 98%