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Updated: Apr 27, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Worse long-term survival after off-pump than on-pump coronary artery bypass grafting
Hisato Takagi1, Takuya Umemoto1,
1Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Insights
Off-pump coronary artery bypass grafting (CABG) may be linked to worse long-term survival compared to on-pump CABG. This meta-analysis of over 100,000 patients suggests a higher mortality risk with the off-pump approach.
Area of Science:
- Cardiovascular Surgery
- Outcomes Research
- Meta-Analysis
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- Off-pump CABG aims to reduce complications associated with cardiopulmonary bypass.
- Long-term survival differences between on-pump and off-pump CABG remain a subject of investigation.
Purpose of the Study:
- To evaluate the association between off-pump CABG and long-term survival.
- To compare long-term all-cause mortality between off-pump and on-pump CABG.
- To synthesize evidence from randomized controlled trials and adjusted observational studies.
Main Methods:
- A comprehensive meta-analysis was conducted.
- Searches included MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials through March 2014.
- Included studies were randomized controlled trials and adjusted observational studies reporting long-term (≥5-year) all-cause mortality.
Main Results:
- The pooled analysis of 22 studies (104,306 patients) showed a significant 7% increase in long-term mortality with off-pump CABG (HR, 1.07; 95% CI, 1.03-1.11).
- Analysis of 17 observational studies (102,820 patients) revealed a significant 7% increase in mortality (HR, 1.07; 95% CI, 1.03-1.11).
- Analysis of 5 randomized trials (1,486 patients) showed a non-significant 14% increase in mortality (HR, 1.14; 95% CI, 0.84-1.56).
Conclusions:
- Off-pump CABG is associated with worse long-term survival compared to on-pump CABG.
- The findings suggest a potential increased mortality risk with off-pump procedures.
- Further research may be warranted to clarify risks in specific patient populations.
Objective:
To determine whether off-pump coronary artery bypass grafting (CABG) is associated with worse long-term survival compared with on-pump CABG. We performed a meta-analysis of adjusted observational studies and randomized controlled trials.
Methods:
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through March 2014. Eligible studies were randomized controlled trials and adjusted observational studies (in which appropriate statistical methods adjusting for confounders had been used) of off-pump versus on-pump CABG that had reported long-term (≥5-year) all-cause mortality as an outcome.
Results:
Of 478 potentially relevant studies screened initially, 5 randomized trials and 17 observational studies, enrolling a total of 104,306 patients, were identified and included. A pooled analysis of all 22 studies demonstrated a statistically significant 7% increase in long-term all-cause mortality with off-pump relative to on-pump CABG (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11; P=.0003). Although a pooled analysis of 5 randomized trials (1486 patients) demonstrated a statistically nonsignificant 14% increase in mortality with off-pump relative to on-pump CABG (hazard ratio, 1.14; 95% confidence interval, 0.84-1.56; P=.39), another pooled analysis of 17 observational studies (102,820 patients) demonstrated a statistically significant 7% increase in mortality with off-pump relative to on-pump CABG (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11; P=.0004).
Conclusions:
A meta-analysis of 22 studies, enrolling a total of >100,000 patients, showed that off-pump CABG is likely associated with worse long-term (≥5-year) survival compared with on-pump CABG.
