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

Abstract

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.

A Cross Sectional Study of Short Term Mortality Assessment of on Pump and Off Pump Cabg Groups with Left Main Coronary Artery Disease

“…But the our present data correlates with kowalewski et al 2020 (4) Study and Giovanni et al 2017 (5) . But Raja et al 2015 (6) , Daniel et al 2016 (7) , studies doesn't correlate with the present study as these studies finds no significant difference in short term mortality between on pump and off pump The short term mortality was highest among age group of 50-69 years on patients undergone on pump cabg and 50 to 59 years for off pump cabg this is against to that of Nicolini et al 2017 (8) which shows highest mortality among 70-89 years followed by 60 to 69 years which can explained as less number of patients above 70 years have undergone procedure in present study The short term mortality was highest among on pump group patients with Ef less than 40 than off pump group correlating with Zhiyuan et al (9) it was found in this study that the left main involvement in multivessel disease had some contribution to the mortality more in on pump group . This was against with Benedetto et al 2019 (11) study and supported by yeatman et al 2001 (10)…”

Pharmacoepidemiology

“…A good example is a study comparing outcomes from coronary artery bypass surgeries performed both with and without pumps. 16 This study concluded that outcomes from both were comparable. The journal that published this study in 2017 stopped publishing in September 2018.…”

Early and Late Survival and Associated Factors in Patients Undergoing Coronary Artery Bypass Grafting

“…In Raja's study, off-pump CABG versus on-pump CABG is correlated with comparable short-, mid-, and long-term mortality, similar organ protection, and fewer distal anastomoses. The available evidence cannot, nonetheless, substantiate all concerns about the safety and efficacy of off-pump CABG [37].…”