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Meta-Analysis
. 2017 Mar 2;50(3):e5711.
doi: 10.1590/1414-431X20165711.

Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Z G Zhu  1 , W Xiong  2 , J L Ding  3 , J Chen  1 , Y Li  1 , J L Zhou  1 , J J Xu  1
Affiliations
Meta-Analysis

Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Z G Zhu et al. Braz J Med Biol Res. .

Abstract

The aim of this study was to analyze if off-pump coronary artery bypass surgery (CABG) is associated with better treatment outcomes in elderly patients (>70 years of age) than on-pump CABG, using meta-analysis. Medline, PubMed, Cochrane and Google Scholar databases were searched until September 13, 2016. Sensitivity and quality assessment were performed. Twenty-two studies, three randomized control trials (RCTs) and 20 non-RCTs were included with 24,127 patients. The risk of death associated with on-pump or off-pump CABG in the RCTs were similar (pooled OR=0.945, 95%CI=0.652 to 1.371, P=0.766). However, in the non-RCTs, mortality risk was lower in patients treated with off-pump CABG than on-pump CABG (pooled OR=0.631, 95%CI=0.587 to 0.944, P=0.003). No differences were observed between the two treatment groups in terms of the occurrence of 30-day post-operative stroke or myocardial infarction (P≥0.147). In the non-RCTs, off-pump CABG treatment was associated with a shorter length of hospital stay (pooled standardized difference in means=-0.401, 95%CI=-0.621 to -0.181, P≤0.001). The meta-analysis with pooled data from non-RCTs, but not RCTs, found that mortality was lower with off-pump compared with on-pump CABG, and suggested that there may be some benefit of off-pump CABG compared with on-pump CABG in the risk of mortality and length of hospital stay.

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Figures

Figure 1
Figure 1. PRISMA flow diagram.
Figure 2
Figure 2. Summary table and forest plot of included studies for treatment effect of off-pump coronary artery bypass surgery (CABG) on mortality compared with on-pump CABG. RCT: randomized clinical trial.
Figure 3
Figure 3. Summary tables and forest plots for treatment effect of off-pump and on-pump coronary artery bypass surgery (CABG) on (A) stroke within 30 days postoperative, (B) myocardial infarction, and (C) length of hospital stay. RCT: randomized clinical trial.
Figure 4
Figure 4. Sensitivity-analysis for treatment effect of off-pump coronary artery bypass surgery (CABG) on mortality compared with on-pump CABG.
Figure 5
Figure 5. Funnel plot for publication bias.
Figure 6
Figure 6. Quality assessment of included studies. A, Risk of bias assessment, and B, individual study assessment.
See this image and copyright information in PMC

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References

    1. Panesar SS, Athanasiou T, Nair S, Rao C, Jones C, Nicolaou M, 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;92:1808–1816. doi: 10.1136/hrt.2006.088450. - DOI - PMC - PubMed
    1. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The multicenter study of perioperative ischemia research group. Ann Inl Med. 1998;128:194–203. doi: 10.7326/0003-4819-128-3-199802010-00005. - DOI - PubMed
    1. Ascione R, Caputo M, Angelini GD. Off-pump coronary artery bypass grafting: Not a flash in the pan. Ann Thorac Surg. 2003;75:306–313. doi: 10.1016/S0003-4975(02)04020-1. - DOI - PubMed
    1. Amar D, Zhang H, Leung DH, Roistacher N, Kadish AH. Older age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology. 2002;96:352–356. doi: 10.1097/00000542-200202000-00021. - DOI - PubMed
    1. Stamou SC, Dangas G, Dullum MK, Pfister AJ, Boyce SW, Bafi AS, et al. Beating heart surgery in octogenarians: Perioperative outcome and comparison with younger age groups. Ann Thorac Surg. 2000;69:1140–1145. doi: 10.1016/S0003-4975(99)01430-7. - DOI - PubMed