Short- and Midterm Outcomes of Off- and On-Pump Coronary Artery Bypass in Patients with a Mean Age of 65 or More: Systematic Review and Meta-Analysis

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Jake E. Trotman, Toluwalase F. Eboka, Neil A. Smart, Nicola King
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引用次数: 0

Abstract

Background. Advancing age is a nonmodifiable risk factor for the development of coronary artery disease. Furthermore, patients >65 years old are considered at high risk for coronary artery bypass grafting (CABG). The aim of this study was to investigate whether there were any differences in clinical outcomes for patients with a mean age ≥65 undergoing CABG on or off pump. Methods. Systematic searches were conducted in EMBASE, PubMed, Web of Science, and Cochrane Central Registry of Controlled Trials (CENTRAL). The key search terms used were “cardiopulmonary bypass” OR “On pump” AND “off pump” OR “beating heart” AND “coronary artery bypass grafting” OR “CABG” AND “age.” This was followed by a meta-analysis assessing the primary outcomes mortality, myocardial infarction, renal failure, and stroke in the short—(30 days) and midterm (12–44 months) and repeat revascularisation at midterm follow up. Secondary outcomes investigated included postoperative atrial fibrillation, number of units of blood transfused, ventilation time, length of intensive care unit stay, and length of hospital stay. Results. 14 studies involving 10,260 participants, 5,141 of whom had on-pump CABG and 5,119 of whom had off-pump CABG were identified. There was a significantly greater need for repeat revascularisation in the off-pump group (risk ratio 1.47, 95% confidence interval 1.07 to 2.01, I2 = 0%, p = 0.02) at midterm follow up. The off-pump group also had a shorter hospital stay. All other comparisons were insignificant. Conclusion. A number of different factors contribute to whether the increased need for repeat revascularisation for off-pump patients is truly clinically significant. This requires further investigation in meta-analysis based on longer-term trials in patients with a mean age ≥65. Otherwise, the similarity in clinical outcomes for patients in this age group suggests the choice to carry out CABG on or off pump should continue to be at the surgeon’s discretion.

Abstract Image

平均年龄为 65 岁或以上的患者使用非泵和泵上冠状动脉搭桥术的短期和中期疗效:系统回顾和元分析
背景。年龄增长是冠状动脉疾病发病的一个不可改变的危险因素。此外,65 岁的患者被认为是冠状动脉旁路移植术(CABG)的高风险人群。本研究旨在探讨平均年龄≥65岁的患者在使用或不使用泵的情况下接受冠状动脉旁路移植术的临床结果是否存在差异。研究方法。在 EMBASE、PubMed、Web of Science 和 Cochrane 对照试验中央登记处 (CENTRAL) 中进行了系统检索。使用的关键检索词为 "心肺旁路术 "或 "开泵 "和 "关泵 "或 "心脏跳动 "和 "冠状动脉旁路移植术 "或 "CABG "和 "年龄"。随后进行了一项荟萃分析,评估了短期(30 天)和中期(12-44 个月)的死亡率、心肌梗死、肾功能衰竭和中风的主要结果,以及中期随访时重复血管再通的情况。次要研究结果包括术后心房颤动、输血单位数、通气时间、重症监护室住院时间和住院时间。研究结果14 项研究共涉及 10,260 名参与者,其中 5,141 人接受了体外循环心脏搭桥术,5,119 人接受了体外循环心脏搭桥术。在中期随访中,非泵组需要重复血管再通的比例明显更高(风险比 1.47,95% 置信区间 1.07 至 2.01,I2 = 0%,P = 0.02)。非泵组的住院时间也更短。所有其他比较结果均不显著。结论非泵患者重复血管重建需求的增加是否具有真正的临床意义,有许多不同的因素。这需要在对平均年龄≥65岁的患者进行的长期试验基础上进行的荟萃分析中进一步研究。否则,该年龄组患者临床结果的相似性表明,选择在泵上还是在泵下进行 CABG 应继续由外科医生决定。
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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