Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13,524 patients from randomized trials

Sá, Michel Pompeu Barros de Oliveira; Ferraz, Paulo Ernando; Escobar, Rodrigo; Martins, Wendell Nunes; Lustosa, Pablo César; Nunes, Eliobas de Oliveira; Vasconcelos, Frederico Pires; Lima, Ricardo Carvalho

doi:10.5935/1678-9741.20120106

Cited by 22 publications

(19 citation statements)

References 48 publications

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“…Two other prior meta-analyses (33,34 ) also evaluated the use of off-pump CABG in cardiovascular surgery, but in contrast to our study, they did not limit their analysis to patients who were ≥70 years of age. The meta-analysis of Sa et al (34) included 47 RCTs with 13,524 patients (6,758 for off-pump and 6,766 for on-pump CABG).…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

“…The meta-analysis of Sa et al (34) included 47 RCTs with 13,524 patients (6,758 for off-pump and 6,766 for on-pump CABG). They found no difference between treatments in 30-day mortality or myocardial infarction.…”

Section: Discussionmentioning

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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“…A meta-analysis of randomized trials comparing on-pump to off-pump coronary artery bypass grafting surgery demonstrated a 20.7% reduction in stroke incidence in off-pump patients (35). However, a Cochrane review of 86 randomized trials did not show a difference in stroke rates when comparing on-pump to off-pump patients (36).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

O’Neal

Billings

Liu

et al. 2017

Can J Anesth/J Can Anesth

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Purpose Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting surgery would correlate with an increased risk of delirium and would be associated with several other outcomes. Methods We reviewed clinical data from two databases at our medical center, the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective coronary artery bypass grafting surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study. Delirium was defined as any positive CAM-ICU exam following surgery during the ICU course. We performed logistic regression to isolate the association between CPB exposure and delirium adjusted for predetermined risk factors and potential confounders. Results During the study period, a total of 2,280 patients underwent elective coronary artery bypass grafting surgery with 384 patients (16.9%) exposed to CPB. Delirium was diagnosed in 451 patients (19.8%). CPB exposure demonstrated a significant independent association with delirium (P = 0.002). The adjusted relative risk (RR) of delirium was 2.18 (95% CI, 1.39 to 3.07; P = 0.002) among patients exposed to CPB for 142 minutes (90th percentile of CPB duration), compared to a RR of only 1.51 (95% CI, 0.92 to 2.29; P = 0.10) for those on CPB for 54 minutes (10th percentile). Conclusions CPB use and duration of use were associated with an increased risk of delirium in patients undergoing coronary artery bypass grafting surgery.

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“…Current best available evidence in the form of metaanalyses and systematic reviews of RCTs as well as propensity score matched studies confirms comparable impact of off and onpump CABG on short, mid, and longterm mortality as well as major cardio and cerebrovascular events with fewer distal anastomoses, poor SVG patency, and increased repeat revascularization rates after offpump CABG. [18][19][20][21][22][23][24][25] Since its renaissance nearly 2 decades ago, offpump CABG has remained a subject of intense scrutiny. It has been compared with the gold standard onpump CABG in numerous RCTs as well as large retrospective observational studies.…”

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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Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13,524 patients from randomized trials

Cited by 22 publications

References 48 publications

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

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

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

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

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