Off-pump coronary artery bypass in patients with left ventricular dysfunction: a meta-analysis

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Medical Technology Assessment

Background:

• Coronary artery bypass (CAB) surgery is standard for multivessel disease with left ventricular dysfunction.
• This study compares on-pump (ONCAB) and off-pump (OPCAB) CAB outcomes in this patient group.

Purpose of the Study:

• To assess and compare the outcomes of ONCAB versus OPCAB in patients with left ventricular dysfunction.
• Key outcomes include mortality (30-day, midterm, late-term), myocardial infarction, and revascularization completeness.

Main Methods:

• A systematic literature search identified 23 nonrandomized studies with 7,759 patients (2,822 OPCAB, 4,937 ONCAB).
• Random effects meta-analysis was employed to aggregate data on mortality and revascularization.
• Sensitivity, heterogeneity, and publication bias were assessed.

Main Results:

• OPCAB was associated with significantly lower early mortality (OR 0.64; 95% CI 0.51-0.81).
• No significant differences in midterm or late-term mortality were observed between groups.
• OPCAB was linked to significantly less complete revascularization.

Conclusions:

• OPCAB may offer an early mortality benefit for patients with impaired left ventricular function.
• Uncertainty in handling conversion-related mortality in studies may affect early mortality findings.
• Higher rates of incomplete revascularization in OPCAB might explain the lack of sustained survival advantage.