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Bypass operation at the beating heart in comparison to the operation with support of the heart-lung machine
Wilhelm Frank1, Brigitte Konta
1ARWIG - Arbeitskreis für wissenschaftsbasierte Gesundheitsversorgung, Wien, Österreich.
Insights
Off-pump coronary artery bypass surgery (OPCAB) and conventional on-pump surgery (CABG) show similar effectiveness and safety. Patient selection criteria are crucial for optimizing outcomes in bypass operations.
Area of Science:
- Cardiovascular Surgery
- Health Technology Assessment
Background:
- Off-pump coronary artery bypass surgery (OPCAB) offers potential advantages over conventional on-pump surgery (CABG).
- HTA report investigates comparative effectiveness, safety, and cost-effectiveness of OPCAB versus CABG.
Purpose of the Study:
- To evaluate the medical effectiveness of off-pump versus on-pump coronary bypass surgery.
- To assess the safety profiles of both surgical techniques.
- To determine the cost-effectiveness of OPCAB compared to CABG.
Main Methods:
- Systematic literature search and classification of articles by evidence hierarchy.
- Inclusion of studies comparing at least two groups (OPCAB vs. CABG).
- Assessment of study quality, patient groups, and outcome parameters.
Main Results:
- Studies show largely equivalent results between OPCAB and CABG.
- No significant clinical superiority or inferiority demonstrated for either technique based on current evidence.
- Heterogeneity in patient groups and outcome measures across studies noted.
Conclusions:
- Current evidence does not prove superiority or inferiority of OPCAB over CABG.
- Diagnostic criteria for patient allocation to surgical techniques are critical.
- Technical limitations necessitate CABG for a majority of bypass surgery patients.
Abstract:
The coronary Bypass operation at the beating heart ("off-pump surgery") is a new procedure which promises advantages in comparison to the established procedure with uses a heart-lung machine ("on-pump-surgery"). In the presented HTA report cardiac surgery the question is investigated, whether there are advantages of the off-pump-surgery in comparison to the on-pump-surgery regarding medical effectiveness, safety as well as cost effectiveness. At the beginning a systematic literature search was done, the articles were classified according to the hierarchy of evidence. There are partly considerable different groups of patients included in the different studies as well as quite different outcome parameters. The quality of the studies in detail, where at least two groups are compared was generally very good.The studies results show more or less equivalent results in the comparison of the two operation techniques. Concluding neither a clinical superiority nor an inferiority on the basis of the present available studies can therefore be proven (off-pump Coronary Artery Bypass; OPCAB) or the conventional bypass operation with use of the heart-lung machine (Coronary Artery Bypass Graft; CABG can).The diagnostic criteria of a patient who is allocated to the one or other operating technique are important. Due to technical reasons the majority of patients with the necessity of a bypass operation con only be treated by CABG, (on-pump-surgery). These criteria for the allocation of operation techniques should be the important components of optimization considerations.
