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Updated: Feb 22, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Use of cardiopulmonary pump support during coronary artery bypass grafting in the high-risk: a meta-analysis
A Yousif1, D Addison2,3, N Lakkis4
1Department of Medicine, Section of Cardiology, University of Oklahoma School of Medicine, Oklahoma City, OK, USA.
Insights
On-pump coronary artery bypass grafting reduces the need for repeat procedures within one year but may increase hospital stay duration in high-risk patients undergoing coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Trials
Background:
- Randomized trials on on-pump versus off-pump coronary artery bypass grafting (CABG) efficacy are inconclusive, especially in high-risk patients.
- High-risk patient criteria include EuroSCORE ≥ 5, age > 70, renal insufficiency, stroke history, and left ventricular dysfunction.
Purpose of the Study:
- To compare outcomes of on-pump versus off-pump CABG in high-risk patient populations.
- To analyze mortality, revascularization rates, stroke, renal failure, and hospital stay.
Main Methods:
- Meta-analysis of randomized control trials (RCTs) published between 2000 and 2016.
- Included studies focused on high-risk patients defined by specific clinical criteria.
- Searched MEDLINE, Scopus, and Embase databases using relevant keywords.
Main Results:
- Nine studies with 11,374 patients (mean age 70) were analyzed.
- No significant differences in mortality, myocardial infarction, or renal failure between on-pump and off-pump groups.
- On-pump CABG showed a decreased need for revascularization at 1 year (OR 0.67) but a longer hospital stay (2.24 days).
Conclusions:
- On-pump CABG is associated with a reduced risk of repeat revascularization within one year.
- This benefit of on-pump CABG may come at the expense of a longer hospital admission.
Background:
Data from randomized trials evaluating the efficacy of on- versus off-pump coronary artery bypass grafting remain inconclusive, particularly in high-risk populations.
Aims:
The aim of this study is to compare the outcomes associated with on- versus off-pump coronary artery bypass grafting among high-risk patients.
Methods:
We performed a meta-analysis of randomized control trials comparing on- versus off-pump coronary artery bypass grafting, focusing on high-risk populations. Studies focusing on "high-risk" features: European System of Cardiac Operative Risk Evaluation (EuroSCORE) ≥ 5, age > 70 years, preexisting renal insufficiency, history of stroke(s), and the presence of left ventricular dysfunction were included. MEDLINE, Scopus, and Embase were searched for all publications between January 1, 2000 and August 1, 2016, using the following terms: on-pump, off-pump, coronary artery bypass, high-risk, left ventricular dysfunction, elderly, aged, and renal insufficiency. Endpoints included cardiovascular and all-cause mortality, non-fatal myocardial infarction, stroke, need for revascularization, renal failure, and length of hospital stay.
Results:
Nine studies incorporating 11,374 patients with a mean age of 70 years were selected. There was no statistical difference in cardiovascular mortality, all-cause mortality, non-fatal myocardial infarction, and renal failure between the two groups. There was a decrease in further revascularization at 1 year with on-pump (OR 0.67 (0.50-0.89)). However, there was an increase in length of hospital stay by 2.24 days (p = 0.03) among the on-pump group with no difference in stroke (OR 1.34 (1.00-1.80)).
Conclusions:
On-pump is associated with a decreased risk of additional revascularization by 1 year. However, this appears to be a cost of longer hospitalization.
