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Updated: Dec 21, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Short-term outcomes of on- vs off-pump coronary artery bypass grafting in patients with left ventricular dysfunction:
Zhiyuan Guan1, Xiaoqing Guan2, Kaiyun Gu1
1Department of Cardiology surgery, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China.
Insights
Off-pump coronary artery bypass grafting (OPCAB) is a superior choice for patients with left ventricular dysfunction compared to on-pump CABG (ONCAB), demonstrating lower mortality and fewer complications. This meta-analysis highlights OPCAB benefits for cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Meta-Analysis and Systematic Reviews
Background:
- Patients with left ventricular dysfunction (LVD) undergoing coronary artery bypass grafting (CABG) present unique surgical challenges.
- The choice between on-pump CABG (ONCAB) and off-pump CABG (OPCAB) strategies for these patients is critical for optimizing outcomes.
Purpose of the Study:
- To compare the in-hospital mortality and morbidities associated with OPCAB versus ONCAB in patients with LVD.
- To evaluate the primary and secondary clinical outcomes of both surgical approaches through a meta-analysis of available evidence.
Main Methods:
- A systematic literature review and meta-analysis were conducted.
- Searched databases included PubMed, EMBASE, Web of Science, and Cochrane.
- Included observational studies and randomized controlled trials comparing OPCAB and ONCAB in multi-vessel coronary artery disease patients with LVD (EF ≤ 40%) from January 1990 to January 2018.
Main Results:
- Analysis of 16 studies (32,354 patients) revealed significant benefits of OPCAB over ONCAB.
- OPCAB was associated with reduced 30-day mortality, stroke, myocardial infarction, renal failure, pulmonary complications, infection, and need for reoperation for bleeding.
- No significant differences were observed in the rates of atrial fibrillation or neurological dysfunction.
Conclusions:
- Off-pump CABG (OPCAB) is a preferable surgical option for patients with left ventricular dysfunction compared to on-pump CABG (ONCAB).
- OPCAB offers significant advantages in reducing mortality and major postoperative morbidities.
- Further randomized controlled trials are recommended to confirm these findings from observational data.
Objectives:
Does the manipulation of the off-pump CABG (OPCAB) in patient with depressed left ventricular function is better than on-pump CABG (ONCAB) approach in in-hospital mortality and morbidities? Here we undertook a meta-analysis of the best evidence available on the comparison of primary and second clinical outcomes of the off-pump and on-pump CABG.
Design:
Systematic literature reviewer and meta-analysis.
Data Sources:
PubMed, EMBASE, Web of science and Cochrane Center Registry of Controlled Trials were searched the studies which comparing the use of the off-pump CABG(OPCAB) and on-pump CABG (ONCAB) for patients with LVD during January 1990.1 to January 2018.
Eligibility Criteria:
All observation studies and randomized controlled trials comparing on-pump and off-pump as main technique for multi-vessel coronary artery disease (defined as severe stenosis (>70%) in at least 2 major diseased coronary arteries) with left ventricular dysfunction(defined as ejection fraction (EF) 40% or less) were included.
Data Extraction And Synthesis:
Authors will screen and select the studies extract the following data, first author, year of publication, trial characters, study design, inclusion and exclusion criteria, graft type, clinical outcome, assess the risk of bias and heterogeneity. Study-specific estimates will pool through the modification of the Newcastle-Ottawa scale for the quality of study and while leave-one-out analysis will be used to detect the impact of individual studies on the robustness of outcomes.
Results:
Among the 987 screened articles, a total of 16 studies (32,354 patients) were included. A significant relationship between patient risk profile and benefits from OPCAB was found in terms of the 30-day mortality (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73-0.97; P = 0.02), stroke (OR, 0.69; 95% CI, 0.55-0.86; P = 0.00), myocardial infarction (MI) (OR, 0.71; 95% CI, 0.53-0.96; P = 0.02), renal failure (OR, 0.71; 95% CI, 0.55-0.93; P = 0.01), pulmonary complication (OR, 0.68; 95% CI, 0.52-0.90; P = 0.01), infection (OR, 0.67; 95% CI, 0.49-0.91; P = 0.00),postoperative transfusion (OR, 0.25; 95% CI, 0.08-0.84; P = 0.02) and reoperation for bleeding (OR, 0.56; 95% CI, 0.41-0.75; P = 0.00). There was no significant difference in atrial fibrillation (AF) (OR, 0.96;95%; CI, 0.78-1.41; P = 0.56) and neurological dysfunction (OR, 0.88; 95% CI, 0.49-1.57; P = 0.65).
Conclusions:
Compared with the on-pump CABG with LVD, using the off-pump CABG is a better choice for patients with lower mortality, stroke, MI, RF, pulmonary complication, infection, postoperative transfusion and reoperation for bleeding. Further randomized studies are warranted to corroborate these observational data.
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