Off‐pump versus on‐pump coronary artery bypass grafting for octogenarians: A meta‐analysis involving 146 372 patients

Abstract

There is an ongoing debate concerning the optimal surgical option of myocardial revascularization for octogenarians. The current meta‐analysis aimed to compare clinical outcomes following off‐pump coronary artery bypass grafting (OPCABG) or conventional coronary artery bypass grafting (CCABG) in octogenarians. PubMed, Cochrane, Web of Science, and EMBASE databases were searched to identify eligible studies from inception to March 2021. The analysis was performed using STATA 15.1. A literature search yielded 18 retrospective studies involving 146 372 patients (OPCABG = 44 522 vs. CCABG = 101 850). Pooled analysis showed a strong trend toward reducing mortality risk in the OPCABG group (odds ratio: 0.75, 95% confidence interval: 0.56–1.00, p = .05). However, it did not reach statistical significance. The sensitive analysis demonstrated that OPCABG was less likely to cause death than CCABG. There were comparable data in myocardial infarction, renal failure, deep sternal wound infection, and hospital stays between the two groups, although the incidence of stroke, atrial fibrillation, prolonged ventilation, and reoperation for bleeding was significantly lower in the OPCAGB group. OPCABG may be an effective surgical strategy for myocardial revascularization, especially in reducing the incidence of postoperative stroke, atrial fibrillation, prolonged ventilation, and reoperation for bleeding.

Concomitant anaortic OPCAB and transfemoral TAVR for high‐risk patients: A case series

“…Furthermore, OPCAB reduces operative blood loss and thus need for transfusion of blood products which are associated with adverse outcomes 32 . Furthermore, OPCAB has been shown to benefit elderly patients, especially those with high calcific load, diabetes, and COPD, reducing their risk of death, stroke, and MI 13,16,33–35 . Finally, the anaortic approach allows for safe intervention in patients with a porcelain aorta, such as in our cohort, mitigating both the technical limitations the condition imposes and the excessive risk of stroke described above.…”

“…32 Furthermore, OPCAB has been shown to benefit elderly patients, especially those with high calcific load, diabetes, and COPD, reducing their risk of death, stroke, and MI. 13,16,[33][34][35] Finally, the anaortic approach allows for safe intervention in patients with a porcelain aorta, such as in our cohort, mitigating both the technical limitations the condition imposes and the excessive risk of stroke described above. This is reflected in the current guidelines-anaortic OPCAB is recognized as a Class I and Class 2a indication for surgical coronary revascularization in patients with a diseased aorta by EACTS 2018 and ACC/AHA 2021 guidelines respectively.…”

Early and mid-term outcomes of off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel coronary artery disease: a randomized controlled trial

“…Different sample sizes, diverse clinical settings and eligibility criteria, primary outcomes, surgeon experience, and duration of follow-up can be mentioned as the most frequent reasons. Variations in eligibility criteria of previous studies, such as enrollment of high-risk patients [ 21 ], number of grafts [ 22 ], age [ 23 , 24 ], history of left main CAD [ 25 ], and ventricular dysfunction [ 26 , 27 ] could be another source of heterogeneity in the result of these studies.…”

Early and Mid-term Outcomes of Off-pump Versus On-pump Coronary Artery Bypass Surgery in Patients With Triple-Vessel Coronary Artery Disease: A Randomized Controlled Trial

“…Different sample sizes, diverse clinical settings and eligibility criteria, primary outcomes, surgeon experience, and duration of follow-up can be mentioned as the most frequent reasons. Variations in eligibility criteria of previous studies, such as enrollment of high-risk patients (22), number of grafts (23), age (24,25), history of left main CAD (26), and ventricular dysfunction (27,28) could be another source of heterogeneity in the result of these studies.…”