Off-Pump Coronary Artery Bypass Reduces Early Stroke in Octogenarians: A Meta-Analysis of 18,000 Patients

Altarabsheh, Salah E.; Deo, Salil V.; Rababa’h, Abeer; Lim, Ju Yong; Cho, Yang Hyun; Sharma, Vikas; Jung, Sung Ho; Shin, Euisoo; Markowitz, Alan H.; Park, Soon J.

doi:10.1016/j.athoracsur.2014.12.057

Cited by 54 publications

(50 citation statements)

References 21 publications

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“…Two prior meta-analyses have compared CABG-related adverse events in elderly patients (≥70 years of age (1) and octogenarians (6) between off-pump and on-pump CABG (1,6). In both studies, off-pump CABG was associated with a lower risk of stroke compared with on-pump CABG.…”

Section: Introductionmentioning

confidence: 99%

Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Zhu

Xiong

Ding

et al. 2017

Braz J Med Biol Res

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The aim of this study was to analyze if off-pump coronary artery bypass surgery (CABG) is associated with better treatment outcomes in elderly patients (>70 years of age) than on-pump CABG, using meta-analysis. Medline, PubMed, Cochrane and Google Scholar databases were searched until September 13, 2016. Sensitivity and quality assessment were performed. Twenty-two studies, three randomized control trials (RCTs) and 20 non-RCTs were included with 24,127 patients. The risk of death associated with on-pump or off-pump CABG in the RCTs were similar (pooled OR=0.945, 95%CI=0.652 to 1.371, P=0.766). However, in the non-RCTs, mortality risk was lower in patients treated with off-pump CABG than on-pump CABG (pooled OR=0.631, 95%CI=0.587 to 0.944, P=0.003). No differences were observed between the two treatment groups in terms of the occurrence of 30-day post-operative stroke or myocardial infarction (P≥0.147). In the non-RCTs, off-pump CABG treatment was associated with a shorter length of hospital stay (pooled standardized difference in means=-0.401, 95%CI=-0.621 to -0.181, P≤0.001). The meta-analysis with pooled data from non-RCTs, but not RCTs, found that mortality was lower with off-pump compared with on-pump CABG, and suggested that there may be some benefit of off-pump CABG compared with on-pump CABG in the risk of mortality and length of hospital stay.

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Section: Introductionmentioning

confidence: 99%

Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Zhu

Xiong

Ding

et al. 2017

Braz J Med Biol Res

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“…Coma leading to death and stroke has obviously a major impact on procedural success and costs [12]. In several meta-analysis studies, the frequency of post-operative stroke remains between 2 and 3 % in conventional CABG [13, 14] and OPCAB with side-biting clamping of the aorta failed to prevent it significantly [2, 3, 15]. On the other hand, anaortic or clampless OPCAB seems to allow a reduction in the stroke rate compared to more conventional surgical strategies [5, 7, 15].…”

Section: Discussionmentioning

confidence: 99%

Partially anaortic clampless off-pump coronary artery bypass prevents neurologic injury compared to on-pump coronary surgery: a propensity score-matched study on 286 patients

et al. 2015

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Anaortic coronary artery bypass proved to prevent early neurologic injury compared to on-pump CABG. The Cardica PAS-Port® is a fully automated device that might be able to perform proximal aorto-venous anastomoses without an increased embolic risk. We evaluated early post-operative neurologic outcome in a matched population following clampless OPCAB (CCAB: either “all-arterial” or with automatically anastomosed venous grafts) or on-pump CABG. 366 consecutive patients were submitted to isolated coronary bypass by a single surgeon experienced in both off and on-pump procedures between January 2009 and December 2013. Of these patients, 223 underwent a clampless off-pump revascularization. After propensity score matching, 143 pairs were selected, who received either off-pump or on-pump surgery. In the off-pump group, CCAB was performed with an all-arterial approach (n = 33) or with automated proximal anastomosis of the venous graft(s) by means of the Cardica PAS-Port® connector (n = 110). Neurologic injury was defined as non-reversible (NRNI: lethal coma or stroke) or reversible (RNI: TIA or delirium). Operative mortality was 2.4 % (CCAB 1.4 %; CABG 3.5 %; p = 0.14). The global rate of early neurologic injury was 5.6 % (CCAB 2.1 vs. CABG 9.1 %; p = 0.006). Incidence was 1.4 % for NRNI (CCAB 0 vs. CABG 2.8 %; p = 0.04) and 4.2 % for RNI (CCAB 2.1 vs. CABG 6.3 %; p = 0.06). No differences were found among other major perioperative outcomes. CCAB prevents both early post-operative RNI and NRNI. This result can be achieved with a totally anaortic strategy and also with the aid of a fully automated device for proximal aorto-venous anastomoses.

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“…Altarabsheh et al [36] reviewed the incidence of postoperative strokes between OPCAB and ONCAB in octogenarians in a meta-analysis involving 16 retrospective studies. There was no difference in 30-day mortality (4.6% OPCAB versus 5.2% ONCAB; P ¼ 0.59), new-onset renal failure, atrial fibrillation, or MIs between the groups.…”

Section: Strokesmentioning

confidence: 99%