Complete revascularization is compromised in off-pump coronary artery bypass grafting

Robertson, Mark; Buth, Karen J.; Stewart, Keir; Wood, J. V.; Sullivan, John A.; Hirsch, Gregory M.; Friesen, Camille L. Hancock

doi:10.1016/j.jtcvs.2012.03.052

Cited by 29 publications

(13 citation statements)

References 22 publications

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“…Similar results were demonstrated by Robertson et al (19) in a retrospective cohort study of 1,285 patients. Following propensity-score matching for baseline characteristics, they reviewed the results of 308 patients undergoing OPCAB compared with 308 patients who had ONCAB.…”

Section: Best Available Evidence For Long-term Survivalsupporting

confidence: 90%

“…Impact of off-pump coronary artery bypass grafting on survival: current best available evidence and freedom from re-intervention (15)(16)(17)(18) with some studies reporting a higher risk of incomplete revascularization and graft failure (19,20). Despite the potential benefits of OPCAB, recent data shows that only a minority of CABG operations worldwide (about 15% to 20%) are carried out with this technique (21).…”

Section: Review Articlementioning

confidence: 99%

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Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

et al. 2016

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Abstract:The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass grafting (CABG) remains unclear despite a large body of literature evidence comparing the two approaches.The potential advantages of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation and maintaining pulsatile flow may be associated with reduced inflammatory responses and embolic events.Numerous studies compared OPCAB with ONCAB and the cumulative data have been presented in metaanalyses of both randomized and observational studies. Although there is an abundance of data with respect to the operative morbidity and mortality and the short-term outcomes associated with these two strategies, not much is known about how they impact long-term survival and recurrence of myocardial ischaemic events. Recent studies and meta-analyses have focused on long-term survival and major secondary outcomes in OPCAB vs. ONCAB within the general population. Significant limitations in methodology, however, have raised concerns about the strength of several randomized trials with restrictive inclusion criteria that reduced the populations to those at low risk only, thus creating result bias. Here, we present a review of the best available evidence with a focus on long-term outcomes.

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Section: Best Available Evidence For Long-term Survivalsupporting

confidence: 90%

Section: Review Articlementioning

confidence: 99%

Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

et al. 2016

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“…26 Moreover, the future trials comparing the effectiveness of off and onpump CABG must include a myocardium at risk score, which is a potentially valuable tool to aid in determining the true significance of the nonrevascularized territory, because there is a recognized hierarchy of effect, depending on which vessels are left ungrafted and how much myocardium is at risk. 27 Furthermore, it is equally important to understand that completeness of revascularization and number of grafts should not be used synonymously. In many centers, offpump CABG is offered to patients who only require one or two grafts, whereas, all else equal, the same patient requiring four or five grafts will not be considered for offpump CABG.…”

Section: Discussionmentioning

confidence: 99%

Off-pump versus on-pump coronary artery bypass grafting: comparative effectiveness

Raja¹

2015

CER

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Background: Historically, coronary artery bypass grafting (CABG) with the use of cardio pulmonary bypass (CPB), referred to as onpump CABG, has been regarded as the "gold standard". However, in recent years, it has been increasingly recognized that the systemic inflammatory response associated with using CPB contributes substantially to postoperative organ dysfunction. Intuitively, performance of CABG without CPB, referred to as offpump CABG, should translate into improved clinical outcomes. Interestingly, no single randomized trial has been able to prove the superiority of offpump CABG over onpump CABG for all hard outcomes, and offpump CABG remains the subject of intense scrutiny as well as controversy. The purpose of the review is to summarize the current best available evidence, comparing the effectiveness of off and onpump CABG. Methods: The English language scientific literature was reviewed primarily by searching MEDLINE from January 2010 to December 2014 using PubMed interface to identify meta analyses and systematic reviews of randomized controlled trials as well as observational studies using propensity score matching, comparing the effectiveness of off and onpump CABG. Results: Current best available evidence from metaanalyses and systematic reviews of randomized controlled trials as well as propensity score analyses suggests that offpump CABG is associated with fewer distal anastomoses, increased repeat revascularization rates, and poor saphenous vein graft patency compared with onpump CABG. No significant differences were observed for other hard outcomes including mortality, myocardial infarction, and stroke. Conclusion: Offpump CABG compared to onpump CABG is associated with similar short, mid, and longterm mortality, comparable organ protection, and fewer distal anastomoses. The concerns about the safety and efficacy of offpump CABG are not substantiated by the current best available evidence. However, the impact of learning curve on outcomes remains a valid issue.

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“…After initial rapid proliferation of OPCAB worldwide, the tempo dampened somewhat because of consistent reports of incomplete revascularisation 18,19 and the first ever RCT comparing the two procedures, the Randomized On/Off Bypass study (ROOBY), showing that at one year follow up OPCAB patients had worse composite outcomes of death, myocardial infarction (MI), graft patency and repeat revascularisation. 20 Patency of grafts placed Off-Pump was sub-optimum even in the one year follow up angiography study of the ROOBY Cohort as also the DOORS Study.…”

Section: Off Pump Vs Pump Surgerymentioning

confidence: 99%

Anaortic total arterial OPCAB – Panacea to all ills?

Yadava

2015

Indian Heart Journal

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Complete revascularization is compromised in off-pump coronary artery bypass grafting

Abstract: Despite receiving fewer distal anastomoses and the decreased frequency of complete revascularization, OPCAB and CCAB techniques produced comparable results.

Cited by 29 publications

References 22 publications

Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

Off-pump versus on-pump coronary artery bypass grafting: comparative effectiveness

Anaortic total arterial OPCAB – Panacea to all ills?

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