On- vs. off-pump coronary artery bypass grafting: A systematic review and meta-analysis

Dieberg, Gudrun; Smart, Neil A.; King, Nicola

doi:10.1016/j.ijcard.2016.08.250

Cited by 46 publications

(48 citation statements)

References 70 publications

(55 reference statements)

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Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown no difference in short‐term (30‐day) mortality between off‐pump beating and on‐pump coronary artery bypass grafting (CABG) . Off‐pump CABG may reduce the incidence of postoperative stroke, renal dysfunction, mediastinitis, and atrial fibrillation . Off‐pump CABG has also been associated with a reduction in the length of ventilation and intensive care unit and hospital stay, less transfusion requirements, and less chest tube drainage .…”

Section: Introductionmentioning

confidence: 99%

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A meta-analysis of ≥5-year mortality in randomized controlled trials of off-pump versus on-pump coronary artery bypass grafting

et al. 2018

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Objectives We sought to determine whether off‐pump coronary artery bypass grafting (CABG) increases long‐term mortality, by performing a meta‐analysis of randomized controlled trials (RCTs) of off‐pump versus on‐pump CABG with ≥5‐year follow‐up. Methods MEDLINE and EMBASE, and the Cochrane Central Register of Controlled Trials were searched through July 2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of long‐term (≥5‐year) mortality for off‐pump versus on‐pump CABG were extracted from each individual trial. Study‐specific estimates were combined using inverse variance‐weighted averages of logarithmic HRs in the random‐effects model. Results Our search identified eight medium‐ to large‐size RCTs at low risk of bias with long‐term follow‐up of off‐pump versus on‐pump CABG enrolling a total of 8780 patients. Combining four RCTs reporting actual HRs generated a statistically significant result favoring on‐pump CABG (HR, 1.21; P = 0.02). A pooled analysis of all eight RCTs demonstrated a statistically significant increase in mortality with off‐pump CABG (HR/RR, 1.19; P = 0.01). There was no evidence of significant publication bias in the meta‐analysis of all eight RCTs. In a sensitivity analysis, extracting RRs or ORs from all eight RCTs and pooling them demonstrated a statistically significant increase in mortality with off‐pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007). Eliminating 2 RRs and combining six HRs still generated a statistically significant result favoring on‐pump CABG (HR, 1.19; P = 0.05). Conclusions Off‐pump CABG increases long‐term (≥5‐year) mortality compared with on‐pump CABG.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A meta-analysis of ≥5-year mortality in randomized controlled trials of off-pump versus on-pump coronary artery bypass grafting

et al. 2018

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“…Patients after off-pump coronary artery bypass grafting (OPCAB) are usually easier to wean, and they have less postoperative respiratory complications in comparison with on-pump surgery (11, 12). However, the number of patients operated with OPCAB technique reaches 60–100% in some regions (13) leading to increased load on the personnel of cardiosurgical ICU.…”

Section: Introductionmentioning

confidence: 99%

“…The role of INTELLiVENT-ASV mode during weaning from ventilation after OPCAB is still unsettled. Thus, it is important to assess efficacy and safety of the automated weaning mode in the off-pump coronary patients (12). …”

Section: Introductionmentioning

confidence: 99%

Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting

et al. 2017

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BackgroundThe discontinuation of mechanical ventilation after coronary surgery may prolong and significantly increase the load on intensive care unit personnel. We hypothesized that automated mode using INTELLiVENT-ASV can decrease duration of postoperative mechanical ventilation, reduce workload on medical staff, and provide safe ventilation after off-pump coronary artery bypass grafting (OPCAB). The primary endpoint of our study was to assess the duration of postoperative mechanical ventilation during different modes of weaning from respiratory support (RS) after OPCAB. The secondary endpoint was to assess safety of the automated weaning mode and the number of manual interventions to the ventilator settings during the weaning process in comparison with the protocolized weaning mode.Materials and methodsForty adult patients undergoing elective OPCAB were enrolled into a prospective single-center study. Patients were randomized into two groups: automated weaning (n = 20) using INTELLiVENT-ASV mode with quick-wean option; and protocolized weaning (n = 20), using conventional synchronized intermittent mandatory ventilation (SIMV) + pressure support (PS) mode. We assessed the duration of postoperative ventilation, incidence and duration of unacceptable RS, and the load on medical staff. We also performed the retrospective analysis of 102 patients (standard weaning) who were weaned from ventilator with SIMV + PS mode based on physician’s experience without prearranged algorithm.Results and discussionRealization of the automated weaning protocol required change in respiratory settings in 2 patients vs. 7 (5–9) adjustments per patient in the protocolized weaning group. Both incidence and duration of unacceptable RS were reduced significantly by means of the automated weaning approach. The FiO2 during spontaneous breathing trials was significantly lower in the automated weaning group: 30 (30–35) vs. 40 (40–45) % in the protocolized weaning group (p < 0.01). The average time until tracheal extubation did not differ in the automated weaning and the protocolized weaning groups: 193 (115–309) and 197 (158–253) min, respectively, but increased to 290 (210–411) min in the standard weaning group.ConclusionThe automated weaning system after off-pump coronary surgery might provide postoperative ventilation in a more protective way, reduces the workload on medical staff, and does not prolong the duration of weaning from ventilator. The use of automated or protocolized weaning can reduce the duration of postoperative mechanical ventilation in comparison with non-protocolized weaning based on the physician’s decision.

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“…Deppe et al also found a reduced incidence of stroke in the off pump group, whilst this group also had an increased need for revascularisation (4). The latest metaanalysis by Dieberg et al reported a P value of 0.05 for the stroke comparison and only found a significant difference in the incidence of atrial fibrillation (7). Two limitations that affect each of these studies are the small size of many of the included RCTs and a concentration on short term (30 days) outcomes (4-7).…”

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confidence: 99%

On vs. off pump coronary artery bypass grafting: the next chapter

King

2017

Ann. Transl. Med.

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On- vs. off-pump coronary artery bypass grafting: A systematic review and meta-analysis

Abstract: Off-pump CABG has some benefits over on-pump CABG, particularly in relation to post-operative atrial fibrillation.

Cited by 46 publications

References 70 publications

A meta-analysis of ≥5-year mortality in randomized controlled trials of off-pump versus on-pump coronary artery bypass grafting

A meta-analysis of ≥5-year mortality in randomized controlled trials of off-pump versus on-pump coronary artery bypass grafting

Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting

On vs. off pump coronary artery bypass grafting: the next chapter

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