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Off-pump versus on-pump coronary surgery in patients with chronic kidney disease: a meta-analysis

Yushu Wang1, Sui Zhu2, Peijuan Gao3

  • 1Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.

Clinical and Experimental Nephrology
|June 22, 2017
PubMed

Insights

Off-pump coronary artery bypass grafting (OPCAB) significantly reduces early mortality and complications in chronic kidney disease (CKD) patients compared to on-pump coronary artery bypass grafting (ONCAB). Long-term survival remains similar for both procedures.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Critical Care Medicine

Background:

  • Patients with chronic kidney disease (CKD) face higher risks of adverse cardiovascular events following coronary artery bypass grafting (CABG).
  • The comparative safety and efficacy of off-pump (OPCAB) versus on-pump (ONCAB) coronary artery bypass grafting in CKD patients remain debated.

Purpose of the Study:

  • To compare the postoperative outcomes of OPCAB versus ONCAB in patients with CKD.
  • To determine the impact of surgical technique on early and long-term adverse cardiovascular outcomes in this high-risk population.

Main Methods:

  • A comprehensive meta-analysis of studies from PubMed, Embase, and Cochrane Library databases.
  • Inclusion of 17 studies involving 201,889 patients comparing OPCAB and ONCAB in CKD patients.
  • Pooled analysis of odds ratios (ORs) and hazard ratios (HRs) with heterogeneity, quality, and publication bias assessments.

Main Results:

  • OPCAB was associated with significantly lower early mortality (OR 0.88) in CKD patients compared to ONCAB.
  • OPCAB demonstrated reduced risks of atrial fibrillation (OR 0.57), cerebrovascular accident (OR 0.46), blood transfusion (OR 0.20), pneumonia, and prolonged ventilation.
  • No significant difference was observed in long-term survival (HR 1.08) or myocardial infarction rates between OPCAB and ONCAB.

Conclusions:

  • OPCAB offers superior postoperative morbidity and reduced early mortality for patients with CKD undergoing coronary artery bypass grafting.
  • Long-term survival outcomes are comparable between OPCAB and ONCAB in this patient cohort.
Abstract

Keywords:
Chronic kidney diseaseCoronary heart diseaseOff-pump coronary artery bypass graftingOn-pump coronary artery bypass grafting

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