Off-pump versus on-pump revascularization in females: a meta-analysis of observational studies
S Attaran1, L Harling2, H Ashrafian2
1Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK.
Insights
Off-pump coronary artery bypass (OPCAB) is a safe alternative for women undergoing coronary revascularization, potentially reducing myocardial infarction. However, it does not significantly lower 30-day mortality or improve other major outcomes compared to on-pump coronary artery bypass (ONCAB).
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Surgery
Background:
- Female patients undergoing coronary revascularization face unique challenges, including smaller vessels and higher comorbidity rates.
- These factors may contribute to increased complication rates compared to male patients.
Purpose of the Study:
- To compare the outcomes of off-pump coronary artery bypass (OPCAB) versus on-pump coronary artery bypass (ONCAB) specifically in female patients.
- To assess if OPCAB offers improved safety and efficacy in this population.
Main Methods:
- A systematic literature review and meta-analysis of six observational studies involving 23,313 female patients.
- Analysis focused on 30-day mortality, major cardiac, respiratory, and renal complications, and graft numbers.
Main Results:
- No significant difference in 30-day mortality between OPCAB and ONCAB groups.
- OPCAB was associated with a significant reduction in peri-operative myocardial infarction (MI) without significant heterogeneity.
- No significant improvement in other major morbidity outcomes or a trend towards fewer grafts per patient with OPCAB.
Conclusions:
- OPCAB is a safe alternative to ONCAB for female coronary revascularization, potentially reducing post-operative MI.
- OPCAB did not translate to reduced 30-day mortality or improved other cardiovascular, renal, or neurological outcomes.
- Further high-quality randomized trials are needed to evaluate long-term outcomes of OPCAB in women.
Background:
Coronary revascularization in female patients presents several challenges, including smaller target vessels and smaller conduits. Furthermore, late presentation and more co-morbidities than males may increase complication rates. The aim of this study was to assess whether off-pump coronary artery bypass (OPCAB) improves outcomes when compared to on-pump coronary artery bypass (ONCAB) in the female population.
Methods:
A systematic literature review identified six observational studies, incorporating 23313 patients (n=9596 OPCAB, 13717 ONCAB). These were meta-analyzed using random effects modeling. Heterogeneity, subgroup analysis, quality scoring and publication bias were assessed. The primary endpoints were 30-day mortality and major cardiac, respiratory and renal complications. Secondary endpoints were the number of grafts per patient.
Results:
No statistically significant difference was observed in 30-day mortality between the OPCAB and ONCAB groups (4.8% vs. 0.7%; OR 0.96; 95% CI [0.41, 2.24], p=0.92). Significant inter-study heterogeneity was also present (I2=94%) and was not explained by study size or quality. Peri-operative myocardial infarction (OR 0.65; 95% CI [0.51, 0.84], p=0.0009) was significantly lower with OPCAB without significant heterogeneity; however, OPCAB did not significantly alter other morbidity outcomes. OPCAB was associated with a trend towards fewer grafts per patient than ONCAB.
Conclusions:
OPCAB is a safe alternative to ONCAB in the surgical revascularisation of female patients and may reduce post-operative myocardial infarction (MI). However, this does not translate into a reduction in 30-day mortality and OPCAB does not significantly improve other cardiovascular, renal or neurological outcomes. Late outcome data remains lacking and a well-structured, randomized trial is required to answer vital questions regarding the effect of OPCAB on women in the long-term.
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