Thorac Cardiovasc Surg 2015; 63(04): 319-327
DOI: 10.1055/s-0035-1544232
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Short-term and Long-term Postoperative Safety of Off-Pump versus On-Pump Coronary Artery Bypass Grafting for Coronary Heart Disease: A Meta-analysis for Randomized Controlled Trials

Taobo Luo
1   Department of Cardiovascular Surgery, Zhejiang University, Zhejiang, China
,
Yiming Ni
1   Department of Cardiovascular Surgery, Zhejiang University, Zhejiang, China
› Author Affiliations
Further Information

Publication History

23 September 2014

18 December 2014

Publication Date:
24 March 2015 (online)

Abstract

Objective The aim was to compare the short-term (30 days after surgery) and long-term (over 6 months' follow-up) postoperative safety of off-pump and on-pump coronary artery bypass grafting (CABG) for patients with coronary heart disease (CHD).

Methods Relevant randomized controlled trials (RCTs) were obtained from PubMed, Embase, Springer, Ovid, and Cochrane library up to July 2013. Odds ratios (ORs) with their 95% confidence intervals (CIs) were used to access effect sizes.

Results Seven RCTs involving 9,128 patients were included. Results suggested no significant difference in all the short-term outcomes (mortality, OR = 0.90, 95% CI: 0.69 to 1.16, p = 0.41; myocardial infarction, OR = 0.95, 95% CI: 0.79 to 1.15, p = 0.61; stroke, OR = 0.78, 95% CI: 0.56 to 1.07, p = 0.12; renal failure, OR = 0.84, 95% CI: 0.60 to 1.18, p = 0.43; revascularization: OR = 1.95, 95% CI: 0.79 to 4.85, p = 0.15) and some long-term outcomes (mortality, OR = 1.02, 95% CI: 0.86 to 1.22, p = 0.81; myocardial infarction, OR = 0.86, 95% CI: 0.70 to 1.04, p = 0.12; stroke, OR = 0.89, 95% CI: 0.67 to 1.19, p = 0.44) between off-pump and on-pump CABG. However, off-pump CABG had a significantly higher revascularization rate (OR = 1.45; 95% CI: 1.02 to 2.06; p = 0.04) than on-pump CABG in long-term follow-up.

Conclusion Short-term postoperative safety was similar between off-pump and on-pump CABG. A high revascularization rate was the drawback of off-pump CABG for CHD patients in long-term follow-up.

 
  • References

  • 1 Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352 (16) 1685-1695
  • 2 de Diego C, Vila-Córcoles A, Ochoa O , et al; EPIVAC Study Group. Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease. Eur Heart J 2009; 30 (2) 209-216
  • 3 Iversen A, Jensen JS, Scharling H, Schnohr P. Hypercholesterolaemia and risk of coronary heart disease in the elderly: impact of age: the Copenhagen City Heart Study. Eur J Intern Med 2009; 20 (2) 139-144
  • 4 Hanna IR, Wenger NK. Secondary prevention of coronary heart disease in elderly patients. Am Fam Physician 2005; 71 (12) 2289-2296
  • 5 Bucher HC, Hengstler P, Schindler C, Guyatt GH. Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials. BMJ 2000; 321 (7253) 73-77
  • 6 Adamu U, Knollmann D, Alrawashdeh W , et al. Results of interventional treatment of stress positive coronary artery disease. Am J Cardiol 2010; 105 (11) 1535-1539
  • 7 Cheng DC, Karski J, Peniston C , et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial. J Thorac Cardiovasc Surg 1996; 112 (3) 755-764
  • 8 Serruys PW, Morice MC, Kappetein AP , et al; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360 (10) 961-972
  • 9 Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 2002; 97 (1) 215-252
  • 10 Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 2002; 21 (2) 232-244
  • 11 Driessen JJ, Dhaese H, Fransen G , et al. Pulsatile compared with nonpulsatile perfusion using a centrifugal pump for cardiopulmonary bypass during coronary artery bypass grafting. Effects on systemic haemodynamics, oxygenation, and inflammatory response parameters. Perfusion 1995; 10 (1) 3-12
  • 12 Kilger E, Pichler B, Goetz AE , et al. Procalcitonin as a marker of systemic inflammation after conventional or minimally invasive coronary artery bypass grafting. Thorac Cardiovasc Surg 1998; 46 (3) 130-133
  • 13 Pfister AJ, Zaki MS, Garcia JM , et al. Coronary artery bypass without cardiopulmonary bypass. Ann Thorac Surg 1992; 54 (6) 1085-1091 , discussion 1091–1092
  • 14 Buffolo E, de Andrade CS, Branco JN, Teles CA, Aguiar LF, Gomes WJ. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 1996; 61 (1) 63-66
  • 15 Serrano Jr CV, Souza JA, Lopes NH , et al. Reduced expression of systemic proinflammatory and myocardial biomarkers after off-pump versus on-pump coronary artery bypass surgery: a prospective randomized study. J Crit Care 2010; 25 (2) 305-312
  • 16 Bainbridge D, Cheng D, Martin J, Novick R ; Evidence-based Peri-operative Clinical Outcomes Research (EPiCOR) Group. Does off-pump or minimally invasive coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with percutaneous coronary intervention? A meta-analysis of randomized trials. J Thorac Cardiovasc Surg 2007; 133 (3) 623-631
  • 17 Cheng DC, Bainbridge D, Martin JE, Novick RJ ; Evidence-Based Perioperative Clinical Outcomes Research Group. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology 2005; 102 (1) 188-203
  • 18 Lemma MG, Coscioni E, Tritto FP , et al. On-pump versus off-pump coronary artery bypass surgery in high-risk patients: operative results of a prospective randomized trial (on-off study). J Thorac Cardiovasc Surg 2012; 143 (3) 625-631
  • 19 Shroyer AL, Grover FL, Hattler B , et al; Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 2009; 361 (19) 1827-1837
  • 20 Panesar SS, Athanasiou T, Nair S , et al. Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass grafting—comparison between off-pump and on-pump techniques. Heart 2006; 92 (12) 1808-1816
  • 21 Parolari A, Alamanni F, Cannata A , et al. Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials. Ann Thorac Surg 2003; 76 (1) 37-40
  • 22 Feng ZZ, Shi J, Zhao XW, Xu ZF. Meta-analysis of on-pump and off-pump coronary arterial revascularization. Ann Thorac Surg 2009; 87 (3) 757-765
  • 23 Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Vol. 5. Wiley Online Library. Chichester: Wiley-Blackwell; 2008
  • 24 Deeks JJ, Altman DG, Bradburn MJ. Statistical Methods for Examining Heterogeneity and Combining Results from Several Studies in Meta-analysis. Systematic Reviews in Health Care: Meta-Analysis in Context, 2nd ed. London: BMJ; 2001: 285-312
  • 25 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414) 557-560
  • 26 Jensen BO, Hughes P, Rasmussen LS, Pedersen PU, Steinbrüchel DA. Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients: a randomized trial. Eur J Cardiothorac Surg 2006; 30 (2) 294-299
  • 27 Møller CH, Perko MJ, Lund JT , et al. No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the best bypass surgery trial. Circulation 2010; 121 (4) 498-504
  • 28 Møller CH, Perko MJ, Lund JT , et al. Three-year follow-up in a subset of high-risk patients randomly assigned to off-pump versus on-pump coronary artery bypass surgery: the Best Bypass Surgery trial. Heart 2011; 97 (11) 907-913
  • 29 Diegeler A, Börgermann J, Kappert U , et al; GOPCABE Study Group. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med 2013; 368 (13) 1189-1198
  • 30 Motallebzadeh R, Bland JM, Markus HS, Kaski JC, Jahangiri M. Health-related quality of life outcome after on-pump versus off-pump coronary artery bypass graft surgery: a prospective randomized study. Ann Thorac Surg 2006; 82 (2) 615-619
  • 31 Houlind K, Kjeldsen BJ, Madsen SN , et al; DOORS Study Group. On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. Circulation 2012; 125 (20) 2431-2439
  • 32 Lamy A, Devereaux PJ, Prabhakaran D , et al; CORONARY Investigators. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012; 366 (16) 1489-1497
  • 33 Lamy A, Devereaux PJ, Prabhakaran D , et al; CORONARY Investigators. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med 2013; 368 (13) 1179-1188
  • 34 Deppe AC, Choi Y, Arbash W , et al. 260 Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of more than 16,500 patients investigated in 66 randomised controlled trials. Interact Cardiovasc Thorac Surg 2014; 19 (Suppl. 01) S78
  • 35 Takagi H, Mizuno Y, Niwa M, Goto SN, Umemoto T ; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. A meta-analysis of randomized trials for repeat revascularization following off-pump versus on-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2013; 17 (5) 878-880
  • 36 Moray G, Boyvat F, Sevmiş S , et al. Vascular complications after liver transplantation in pediatric patients. Transplant Proc 2005; 37 (7) 3200-3202
  • 37 Kane GC, Xu N, Mistrik E, Roubicek T, Stanson AW, Garovic VD. Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis. Nephrol Dial Transplant 2010; 25 (3) 813-820
  • 38 Scalia R. Statins and the response to myocardial injury. Am J Cardiovasc Drugs 2005; 5 (3) 163-170
  • 39 Hu S, Zheng Z, Yuan X , et al. Increasing long-term major vascular events and resource consumption in patients receiving off-pump coronary artery bypass: a single-center prospective observational study. Circulation 2010; 121 (16) 1800-1808
  • 40 Köksal C, Sarikaya S, Ozcan V, Zengin M. Simultaneous off-pump coronary revascularization with pulmonary resection or vascular surgery. Middle East J Anaesthesiol 2004; 17 (6) 1069-1077
  • 41 Toursarkissian B, D'Ayala M, Stefanidis D , et al. Angiographic scoring of vascular occlusive disease in the diabetic foot: relevance to bypass graft patency and limb salvage. J Vasc Surg 2002; 35 (3) 494-500
  • 42 Attaran S, Harling L, Ashrafian H , et al. Off-pump versus on-pump revascularization in females: a meta-analysis of observational studies. Perfusion 2014; 29 (5) 385-396
  • 43 Kuss O, von Salviati B, Börgermann J. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses. J Thorac Cardiovasc Surg 2010; 140 (4) 829-835 , 835.e1–835.e13
  • 44 Vasques F, Rainio A, Heikkinen J , et al. Off-pump versus on-pump coronary artery bypass surgery in patients aged 80 years and older: institutional results and meta-analysis. Heart Vessels 2013; 28 (1) 46-56
  • 45 Chaudhry UA, Harling L, Rao C , et al. Off-pump versus on-pump coronary revascularization: meta-analysis of mid- and long-term outcomes. Ann Thorac Surg 2014; 98 (2) 563-572
  • 46 Zhang B, Zhou J, Li H, Zhou M, Chen A, Zhao Q. Off-pump coronary artery bypass grafting does not increase the 1-year mortality compared to on-pump: a meta-analysis of randomized controlled trials. Int J Cardiol 2013; 169 (5) e93-e95