Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery

Hannan, Edward L.; Wu, Chuntao; Smith, Craig R.; Higgins, Robert S.D.; Carlson, Russell E.; Culliford, Alfred T.; Gold, Jeffrey P.; Jones, Robert H.

doi:10.1161/circulationaha.106.675595

Cited by 259 publications

(52 citation statements)

References 51 publications

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“…A further effort in minimizing the occurrence of some complications related to conventional CABG has led to the development of the off‐pump (OPCAB) technique in which the anastomoses are performed on the beating heart 4. Observational studies have suggested that, by avoiding the negative effects of CBP, OPCAB may substantially reduce the rate of mortality and morbidity when compared with conventional CABG 30, 31 and in particular in high‐risk patients 5, 32. Standard OPCAB, however, still requires application of a side biting clamp to complete proximal anastomoses, thus increasing the risk of dislodging fragile material from the aortic wall.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Pawliszak

Kowalewski

Raffa

et al. 2016

JAHA

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BackgroundOff‐pump coronary artery bypass (OPCAB) has been shown to reduce the risk of neurologic complications as compared to coronary artery bypass grafting performed with cardiopulmonary bypass. Side‐clamping of the aorta while constructing proximal anastomoses, however, still carries substantial risk of cerebral embolization. We aimed to perform a comprehensive meta‐analysis of studies assessing 2 clampless techniques: aortic “no‐touch” and proximal anastomosis devices (PAD) for OPCAB.Methods and ResultsPubMed, CINAHL, CENTRAL, and Google Scholar databases were screened for randomized controlled trials and observational studies comparing “no‐touch” and/or PAD with side‐clamp OPCAB and reporting short‐term (≤30 days) outcomes: cerebrovascular accident and all‐cause mortality. A total of 18 studies (3 randomized controlled trials) enrolling 25 163 patients were included. Aortic “no‐touch” was associated with statistically lower risk of cerebrovascular accident as compared to side‐clamp OPCAB: risk ratio 95% CI: 0.41 (0.27–0.61); P<0.01; I2=0%. Event rates were 0.36% and 1.28% for “no‐touch” and side‐clamp OPCAB, respectively. No difference was seen between PAD and side‐clamp OPCAB: 0.71 (0.33–1.55); P=0.39; I2=39%. A trend towards increased 30‐day all‐cause mortality with PAD and no difference with “no‐touch” were observed when compared to side‐clamp OPCAB. In a subset analysis, “no‐touch” consistently reduced the risk of cerebrovascular accident regardless of patients’ baseline risk characteristics. A benefit with PAD was observed in low‐risk patients.ConclusionsAortic “no‐touch” technique was associated with nearly 60% lower risk of postoperative cerebrovascular events as compared to conventional side‐clamp OPCAB with effect consistent across patients at different risk.

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Section: Discussionmentioning

confidence: 99%

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Pawliszak

Kowalewski

Raffa

et al. 2016

JAHA

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“…Off-pump coronary artery bypass surgery (OPCAB) has a comparable risk-adjusted mortality and morbidity as on-pump CABG [6][7][8]. Current reports suggest OPCAB to be superior for high-risk patients [9].…”

Section: Introductionmentioning

confidence: 99%

Off-pump surgery for the poor ventricle?

et al. 2011

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Severely decreased ejection-fraction is an established risk-factor for worse outcome after cardiac surgery. We compare outcomes of off-pump coronary artery bypass grafting (OPCAB) and on-pump CABG (ONCABG) in patients with severely compromised EF. From 2004 to 2009, 478 patients with a decreased EF B35% underwent myocardial-revascularization. Patients received either OPCAB (n = 256) or ONCABG (n = 222). Propensity score (PS), including 50 preoperative risk-factors, was used to balance characteristics between groups. PS adjusted logistic regression analysis was performed to assess mortality and major adverse cardiac and cerebrovascular events (MACCE). A composite endpoint for major non-cardiac complications such as respiratory failure, renal failure, rethoracotomy was applied. Complete revascularization (CR) was assumed when the number of distal anastomoses was larger than that of diseased vessels. There was no difference for mortality (2.3 vs. 4.1%; PS-adjusted odds ratio (PS-OR) = 1.05; p = 0.93) and MACCE (13.7 vs. 17.6%; PS-OR = 1.22; p = 0.50) including myocardial-infarction (1.4 vs. 4.9%; PS-OR = 0.39; p = 0.26), low cardiac output (2.3 vs. 4.7%; PS-OR = 0.75; p = 0.72) and stroke (2.3 vs.2.7%; PS-OR = 0.69; p = 0.66). OPCAB patients presented with a trend to less frequent occurrence of the non-cardiac composite (12.1 vs. 22.1%; PS-OR = 0.54; p = 0.059) including renal dysfunction (PAOR = 0.77; 95% CI 0.31-1.9; p = 0.57), bleeding (PAOR = 0.42; 95% CI 0.14-1.20; p = 0.10) and respiratory failure (PAOR = 0.39; 95% CI 0.05-3.29; p = 0.39). The rate of complete revascularization was similar (92.2 vs. 92.8%; PS-OR = 0.75; p = 0.50). OPCAB in patients with severely decreased EF is safe and feasible. It may even benefit these patients in regard to non-cardiac complications and does not come at cost of less complete revascularization.

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“…Se ha descrito que la cirugía sin CEC se asocia a un menor número de puentes que la cirugía con CEC 6,22,23 . Creemos que esto no necesariamente refleja una revascularización incompleta.…”

Section: Resultados Inmediatosunclassified

“…Hannan y cols estudiaron 13.889 pacientes operados sin CEC con 35.941 pacientes operados con CEC entre los años 2001 y 2004 en el estado de Nueva York. Observaron que a tres años la probabilidad de estar libre de una revascularización fue 93,6% en los pacientes intervenidos con bomba versus 89,9% en los operados sin CEC 6 . Recientemente el estudio ROOBY distribuyó en forma aleatoria 2.203 pacientes a cirugía con o sin CEC.…”

Section: Discussionunclassified