Impact of avoiding cardioplegic arrest on clinical outcome in patients undergoing CABG in Bangladesh: a systematic review and meta-analysis

Abstract

Objectives: Over the last decade, the practice of surgical revascularization for the coronary artery disease has been popularized in Bangladesh. Our aim was to compare the outcome of non-cardioplegic versus cardioplegic coronary artery bypass surgery in terms of early postoperative outcomes.

Methods: A literature search was conducted in March 2020 on Medline (via PubMed), Scopus and Bangladesh Journal Online electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All randomized controlled trials and observational studies reporting findings of coronary revascularization surgery comparing the outcomes were included.

Results: Fifteen studies were used quantitatively that included a total cohort of 4750 coronary artery bypass graft (CABG) patients in Bangladesh. After the meta-analysis, we observed a longer duration of operating time [mean difference (MD): - 52.30, confidence interval (CI): - 67.73 to - 36.86, I ² 18 = 89%, p < 0.00001] and a higher incidence of postoperative atrial fibrillation [risk ratio (RR): 0.43, CI: 0.14 to 0.80, I ² = 44%, p = 0.01] in the cardioplegic CABG group as compared with the non-cardioplegic group. Additionally, statistically significant longer duration of ventilation time (MD: - 8.64, CI: - 9.47 to - 7.82, I ² = 82%, p < 0.00001) and ICU stay (MD: - 17.25, CI: - 33.36 to - 1.14, I ² = 99%, p = 0.04) was observed in the cardioplegic group. No significant differences in number of grafts and in-hospital mortality were found between the two groups.

Conclusion: Non-cardioplegic CABG may be a viable alternative to cardioplegic CABG in Bangladeshi population, providing similar postoperative outcomes but offering additional advantage of shorter operation and ventilation times.

Keywords: Bangladesh; Beating heart; Conventional coronary artery bypass grafting; Meta-analysis.

Fig. 1

Risk of bias assessments for (A) randomized controlled trials and (B) non-randomized controlled trials. Green (+) indicates criterion was low risk; red (−) indicates criterion was high risk; yellow (?) indicates criterion had an unclear risk

Fig. 2

PRISMA flow diagram for CABG in Bangladesh, illustrating the screening process used

Fig. 3

Forest plots of primary outcomes: (A) operation time, (B) number of grafts, (C) in-hospital mortality

Fig. 4

Forest plots of secondary outcomes: (A) postoperative atrial fibrillation, (B) ventilation time, (C) ICU stay