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. 2022 Apr 25:9:869987.
doi: 10.3389/fcvm.2022.869987. eCollection 2022.

A Meta-Analysis of Early, Mid-term and Long-Term Mortality of On-Pump vs. Off-Pump in Redo Coronary Artery Bypass Surgery

Shicheng Zhang  1 , Siyuan Huang  1 , Xieraili Tiemuerniyazi  1 , Yangwu Song  1 , Wei Feng  1
Affiliations

A Meta-Analysis of Early, Mid-term and Long-Term Mortality of On-Pump vs. Off-Pump in Redo Coronary Artery Bypass Surgery

Shicheng Zhang et al. Front Cardiovasc Med. .

Abstract

We aimed to compare the early, mid-term, and long-term mortality between on-pump vs. off-pump redo coronary artery bypass grafting (CABG). We conducted a systematic search for studies comparing clinical outcomes of patients who underwent on-pump vs. off-pump redo CABG. We pooled the relevant studies quantitatively to compare the early (perioperative period, whether in hospital or within 30 days after discharge), mid-term (≥1 year and <5 years), and long-term (≥5 year) mortality of on-pump vs. off-pump redo CABG. A random-effect model was applied when there was high heterogeneity (I2 > 50%) between studies. Otherwise, a fixed-effect model was utilized. After systematic literature searching, 22 studies incorporating 5,197 individuals (3,215 in the on-pump group and 1,982 in the off-pump group) were identified. A pooled analysis demonstrated that compared with off-pump redo CABG, on-pump redo CABG was associated with higher early mortality (OR 2.11, 95%CI: 1.54-2.89, P < 0.00001). However, no significant difference was noted in mid-term mortality (OR 1.12, 95%CI: 0.57-2.22, P = 0.74) and long-term mortality (OR 1.12, 95%CI: 0.41-3.02, P = 0.83) between the two groups. In addition, the complete revascularization rate was higher in the on-pump group than the off-pump group (OR 2.61, 95%CI: 1.22-5.60, P = 0.01). In conclusion, the off-pump technique is a safe and efficient alternative to the on-pump technique, with early survival advantage and similar long-term mortality to the on-pump technique in the setting of redo CABG, especially in high-risk patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021244721.

Keywords: comparison; mortality; off-pump; on-pump; redo coronary artery bypass grafting.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) study selection flow diagram.
Figure 2
Figure 2
Funnel plot for early mortality.
Figure 3
Figure 3
Funnel plot for mid-term mortality.
Figure 4
Figure 4
Funnel plot for long-term mortality.
Figure 5
Figure 5
Funnel plot for total revascularization rate.
Figure 6
Figure 6
Funnel plot for perioperative neurological events.
Figure 7
Figure 7
Forest plot for early mortality.
Figure 8
Figure 8
Forest plot for mid-term mortality.
Figure 9
Figure 9
Forest plot for long-term mortality.
Figure 10
Figure 10
Forest plot for total revascularization rate.
Figure 11
Figure 11
Forest plot for perioperative neurological events.
See this image and copyright information in PMC

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