Comparison of graft patency between off-pump and on-pump coronary artery bypass grafting: an updated meta-analysis

Abstract

Background: Currently, off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB) are 2 well-established therapeutic strategies for patients with coronary artery disease, and debate regarding which strategy provides superior graft patency is ongoing. The current study is a meta-analysis of randomized controlled trials that compared the graft patency between OPCAB and ONCAB.

Methods: Data sources were PubMed, the Cochrane Library, Google Scholar, and ISI Web of Knowledge (1966-2013). We identified studies comparing graft patency after the 2 procedures as the primary intervention for patients with multivessel coronary artery disease and conducted a meta-analysis of randomized controlled trials on graft patency.

Results: A literature search yielded 12 randomized controlled trials, for a total of 3,894 and 4,137 grafts performed during OPCAB and ONCAB procedures, respectively. Meta-analysis of these studies showed an increased risk of occlusion of all grafts (risk ratio [RR], 1.35; 95% confidence interval [CI], 1.16-1.57) and saphenous vein grafts (SVGs) (RR, 1.41; 95% CI, 1.24-1.60) in the OPCAB group, whereas there was no significant difference in graft occlusion of left internal mammary artery (LIMA) (RR, 1.15; 95% CI, 0.83-1.59) and radial artery (RR, 1.37; 95% CI, 0.76-2.47) grafts between OPCAB and ONCAB.

Conclusions: Meta-analysis of currently available randomized controlled trials on graft patency shows that ONCAB reduces the incidence of SVG graft occlusion significantly but does not affect LIMA and radial artery graft patency compared with OPCAB.