Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies

Abstract

Off-pump coronary artery bypass surgery (OPCAB) has been hypothesised to be beneficial in the high-risk patient population undergoing re-operative coronary artery bypass graft surgery (CABG). In addition, this technique has been demonstrated to provide subtle benefits in end-organ function including heart, lungs and kidney. The aims of this study were to assess whether OPCAB is associated with a lower incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and other adverse outcomes in re-operative coronary surgery. Twelve studies, incorporating 3471 patients were identified by systematic literature review. These were meta-analysed using random-effects modelling. Primary endpoints were MACCE and other adverse outcomes including myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation. A significantly lower incidence of myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation was observed with OPCAB (OR 0.58; 95% CI (confidence interval) [0.39-0.87]; OR 0.37; 95% CI [0.17-0.79]; OR 0.39; 95% CI [0.24-0.63]; OR 0.14; 95% CI [0.04-0.56]; OR 0.36; 95% CI [0.24-0.54]; OR 0.41; 95% CI [0.22-0.77] respectively). Sub-group analysis using sample size, matching score and quality score was consistent with and reflected these significant findings. Off-pump coronary artery bypass grafting reduces peri-operative and short-term major adverse outcomes in patients undergoing re-operative surgery. Consequently we conclude that OPCAB provides superior organ protection and a safer outcome profile in re-operative CABG.

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“…Isolated coronary artery bypass grafting, and cardiopulmonary bypass (CPB)'s extensive usage have been made well before the beating heart (Kolessov 1967). (1)(2)(3)(4) CPB's side effects (inflammation, stroke, hemorrhage, renal failure, pulmonary insufficiency, etc.) have been a drawback.…”

“…Benetti began to perform the Buffalo beating heart in a case of large series in 1990 and 1997. (2)(3)(4) Despite increasing technological innovation, the CPB's disadvantages have been increased by age in the following years. Convincing the CABG patients to become candidates is also important.…”

“…Coronary artery bypass graft (CABG) is a superior management approach for severe coronary artery disease. (1)(2)(3) The left internal thoracic artery is considered to be the best conduit for CABG. (2)(3)(4) However, preferred standard coronary artery bypass grafting technique remains controversial between off pump and on pump or hybrid coronary revascularization.…”

“…Also, the off pump patients had less perioperative death and lower incidences of all morbidities as present reports. (1)(2)(3)(4) Panoulas et al (6) have demonstrated that the excellent patency rates of drug-eluting stents associated with HCR survival benefits. In the study of Harskamp et al (7) they detected that among diabetic patients with percutaneous coronary intervention (PCI) of non-left anterior descending vessels are safety and efficacy.…”

The future of off-pump coronary artery bypass grafting: a North American perspective

“…Retrospective data from specific high-risk subpopulations suggest significant benefit from an OPCAB approach (9)(10)(11)(12). These subpopulations may include females (10) and patients in the highest two predicted risk quartiles (3,9).…”