Off-pump versus on-pump myocardial revascularization in patients with ST-segment elevation myocardial infarction: A randomized trial

Fattouch, Khalil; Guccione, Francesco; Dioguardi, Pietro; Sampognaro, Roberta; Corrado, Egle; Caruso, Marco; Ruvolo, Giovanni

doi:10.1016/j.jtcvs.2008.11.033

Cited by 62 publications

(54 citation statements)

References 25 publications

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“…In the same meta-analysis (3) there was no difference in atrial fibrillation rates between off-pump versus on-pump, contrary to a smaller, previous meta-analysis of RCTs (37) ( Table 8). (14) while the late mortality did not differ compared to conventional surgery (42). Several retrospective studies found a benefit in using off-pump techniques in other high risk groups such as: females (43) or reoperative coronary artery bypass grafting (44).…”

Section: Postoperative Renal Dysfunctionmentioning

confidence: 93%

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Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials

et al. 2016

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Coronary artery bypass grafting remains the standard treatment for patients with extensive coronary artery disease. Coronary surgery without use of cardiopulmonary bypass avoids the deleterious systemic inflammatory effects of the extracorporeal circuit. However there is an ongoing debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass (ONCAB versus OPCAB) surgery. The current review is based on evidence from randomized controlled trials (RCTs) and metaanalyses of randomized studies. It focuses on operative mortality, mid-and long-term survival, graft patency, completeness of revascularisation, neurologic and neurophysiologic outcomes, perioperative complications and outcomes in the high risk groups. Early and late survival rates for both OPCAB and ONCAB grafting are similar. Some studies suggest early poorer vein graft patency with off-pump when compared with onpump, comparable midterm arterial conduit patency with no difference in long term venous and arterial graft patency. A recent, pooled analysis of randomised trials shows a reduction in stroke rates with use offpump techniques. Furthermore, OPCAB grafting seems to reduce postoperative renal dysfunction, bleeding, transfusion requirement and respiratory complications while perioperative myocardial infarction rates are similar to ONCAB grafting. The high risk patient groups seem to benefit from off-pump coronary surgery. Developed about 40 decades ago (5-7), OPCAB reached a plateau in Europe, accounting for nearly 15-20% of all coronary operations, while in Asia 60-100% of patients are offered coronary artery bypass grafting (2). A retrospective analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database in USA revealed a decline in off-pump operations, currently being used in fewer than one out of five patients (8). The current review focuses on the main outcomes of on-pump coronary artery bypass (ONCAB) grafting versus OPCAB from randomized controlled trials (RCTs) (i.e., level I evidence). The main criticism of RCTs in this area, is the under powering because of recruitment of low risk patients but also because of the low mortality and morbidity of coronary artery bypass grafting that would require very large sample populations to detect a difference (4). Therefore, we will also be reviewing pooled data from recent, updated meta-analyses of randomized trials only. We selected in our review large sample size RCTs or large meta-analyses of RCTs to discuss the hard end-point outcomes but smaller trials were also included to discuss other outcomes. Operative mortalityThe majority of the large RCTs to date failed to show a difference in early mortality between off-pump and on-pump surgery (1,3,9-13). One small sample size RCT by Fattouch et al. showed a reduced mortality in patients with ST elevation undergoing urgent/emergent off-pump coronary surgery compared to on-pump surgery (14). Deppe et al. in meta-analysis of RCTs on almost 16,900 patients found no difference in 30-day mortality. Kow...

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Section: Postoperative Renal Dysfunctionmentioning

confidence: 93%

“…One small sample size RCT by Fattouch et al showed a reduced mortality in patients with ST elevation undergoing urgent/emergent off-pump coronary surgery compared to on-pump surgery (14). Deppe et al in meta-analysis of RCTs on almost 16,900 patients found no difference in 30-day mortality.…”

Section: Operative Mortalitymentioning

confidence: 99%

Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials

et al. 2016

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“…Hence, the complications of the most complicated OPCAB-procedures were exported to the CCABG-group. It is worth noting that one of the few randomized studies that specifically included high-risk patients who received an acute operation, found a significantly higher mortality in the CCABG group than in the OPCAB group (7.7% vs. 1.6%, p=0.04) (32). However, this study exclusively included patients who only needed grafting the LAD territory, which would be expected to favour OPCAB.…”

Section: Periperative Mortalitymentioning

confidence: 83%

“…However, many randomized studies provide evidence of a lower, subclinical release of biochemical markers of myocardial damage among patient operated using OPCAB (12,25,(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). This tendency is very robust across the different studies, and it is even preset in a study that showed a significantly higher proportion of graft occlusions in the OPCAB group (25).…”

Section: Myocardial Damagementioning

confidence: 97%

“…In the other study, a shorter time to extubation and shorter stay in intensive care unit was found among OPCAB patients (63). Also, in a study of patients with recent myocardial infarction, a shorter ventilation time was documented for OPCAB-patients compared to CCABG-patients (32). It has been suggested, that the mechanism behind impaired lung function after CCABG was changes in alveolar gas exchange as a result of increased interstitial oedema.…”

Section: Lung Functionmentioning

confidence: 98%

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Current Evidence of On-Pump Versus Off-Pump Coronary Artery By-Pass Surgery

Houlind¹

2012

Special Topics in Cardiac Surgery

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Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

Møller

Penninga

Wetterslev

et al. 2012

Cochrane Database of Systematic Reviews

143

118

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Our systematic review did not demonstrate any significant benefit of off-pump compared with on-pump CABG regarding mortality, stroke, or myocardial infarction. In contrast, we observed better long-term survival in the group of patients undergoing on-pump CABG with the use of cardiopulmonary bypass and cardioplegic arrest. Based on the current evidence, on-pump CABG should continue to be the standard surgical treatment. However, off-pump CABG may be acceptable when there are contraindications for cannulation of the aorta and cardiopulmonary bypass. Further randomised clinical trials should address the optimal treatment in such patients.

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Off-pump versus on-pump myocardial revascularization in patients with ST-segment elevation myocardial infarction: A randomized trial

Cited by 62 publications

References 25 publications

Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials

Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials

Current Evidence of On-Pump Versus Off-Pump Coronary Artery By-Pass Surgery

Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

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