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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis
Pengbin Zhang1,2, Liping Wang1, Kerong Zhai1,2
1Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
Insights
Off-pump redo coronary artery bypass grafting (CABG) significantly reduces 30-day and in-hospital mortality compared to on-pump procedures. This meta-analysis shows fewer complications and shorter hospital stays with the off-pump technique.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Outcomes Research
Background:
- Redo coronary artery bypass grafting (CABG) carries higher risks than primary procedures.
- Comparing off-pump versus on-pump techniques in redo CABG is crucial for patient outcomes.
Purpose of the Study:
- To systematically evaluate and compare the outcomes of off-pump versus on-pump redo CABG.
- To synthesize evidence on mortality, complications, and resource utilization.
Main Methods:
- Systematic literature search across major databases (PubMed, EMBASE, Cochrane Library, ICTRP).
- Meta-analysis of 21 studies involving 4,889 patients.
- Primary outcome: 30-day mortality; Secondary outcomes: in-hospital mortality, complications, revascularization, transfusion, ventilation, and length of stay.
Main Results:
- Off-pump redo CABG demonstrated significantly lower 30-day mortality (OR=0.43) and in-hospital mortality (OR=0.55).
- Reduced incidence of post-operative atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output, and blood transfusions observed with off-pump.
- Shorter mechanical ventilation duration, ICU, and hospital stays were associated with the off-pump technique.
Conclusions:
- Off-pump redo CABG is associated with decreased mortality and fewer post-operative complications compared to on-pump.
- The off-pump approach appears to be a safer and more efficient strategy for redo CABG surgery.
Background:
Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG.
Methods:
Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays.
Results:
The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = -8.21 h, 95% CI = -11.74 to -4.68, p < 0.00001; MD = -0.77 d, 95% CI = -0.81 to -0.73, p < 0.00001; MD = -2.24 d, 95% CI = -3.17 to -1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization.
Conclusion:
In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.
