Off-pump versus on-pump coronary artery bypass grafting in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

General Thoracic and Cardiovascular Surgery Pub Date : 2025-04-01 Epub Date: 2025-01-23 DOI:10.1007/s11748-025-02116-3

Anelise Poluboiarinov Cappellaro, Luiz F Costa de Almeida, Manoela Lenzi Pinto, Marcelo Albuquerque Barbosa Martins, Augusto Graziani E Sousa, Júlia Gonçalves Gadelha, Ana Carolina Putini Vieira, Luís Fernando Rosati Rocha, Myat Soe Thet

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引用次数: 0

Abstract

Introduction: Off-pump coronary artery bypass graft surgery (OPCAB) has been suggested as superior to on-pump coronary artery bypass graft surgery (ONCAB) in certain high-risk subgroups, but its benefit in patients with chronic obstructive pulmonary disease (COPD) remains controversial. This meta-analysis aimed to evaluate OPCAB versus ONCAB outcomes in COPD patients.

Methods: We followed PRISMA guidelines and searched PubMed, Embase, and the Cochrane Library in August 2024 for studies comparing OPCAB and ONCAB in COPD patients. Statistical analysis was conducted using Review Manager 5.4.1 and Rstudio with a fixed or random effects model.

Results: Six studies with a total of 1,687 patients were included, of which 1,062 (62.95%) underwent OPCAB. The mean patient age was 63.6 years. OPCAB did not significantly affect all-cause mortality compared to ONCAB (OR 1.14; 95% CI 0.65-1.99). There were no significant differences in reintubation (OR 0.81; 95% CI 0.53-1.23), prolonged ventilation (OR 0.54; 95% CI 0.24-1.22), post-operative atrial fibrillation (OR 0.90; 95% CI 0.70-1.15), or ARDS (OR 0.43; 95% CI 0.14-1.33). However, ventilation time was significantly shorter in the OPCAB group (MD - 5.30 h; 95% CI - 7.22 to - 3.38).

Conclusion: OPCAB is associated with reduced ventilation time in COPD patients though it shows no significant difference in all-cause mortality or other post-operative complications compared to ONCAB.

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慢性阻塞性肺疾病患者非体外循环与非体外循环冠状动脉旁路移植术：一项系统综述和荟萃分析

在某些高危亚组中，非体外循环冠状动脉旁路移植术（OPCAB）优于非体外循环冠状动脉旁路移植术（ONCAB），但其对慢性阻塞性肺疾病（COPD）患者的益处仍存在争议。本荟萃分析旨在评估OPCAB与ONCAB在COPD患者中的疗效。方法：我们遵循PRISMA指南，于2024年8月检索PubMed、Embase和Cochrane图书馆，以比较OPCAB和ONCAB在COPD患者中的应用。采用Review Manager 5.4.1和Rstudio进行统计分析，采用固定或随机效应模型。结果：纳入6项研究，共1687例患者，其中1062例（62.95%）行OPCAB。患者平均年龄为63.6岁。与ONCAB相比，OPCAB对全因死亡率无显著影响(OR 1.14；95% ci 0.65-1.99)。两组再插管无显著性差异(OR 0.81；95% CI 0.53-1.23)，延长通气时间(OR 0.54；95% CI 0.24-1.22)，术后房颤(OR 0.90；95% CI 0.70-1.15)或ARDS (or 0.43；95% ci 0.14-1.33)。然而，OPCAB组通气时间明显缩短(MD - 5.30 h；95% CI - 7.22至- 3.38)。结论：与ONCAB相比，OPCAB与COPD患者通气时间缩短有关，但在全因死亡率和其他术后并发症方面无显著差异。

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来源期刊

General Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine

CiteScore

2.70

自引率

8.30%

发文量

142

期刊介绍： The General Thoracic and Cardiovascular Surgery is the official publication of The Japanese Association for Thoracic Surgery and The Japanese Association for Chest Surgery, the affiliated journal of The Japanese Society for Cardiovascular Surgery, that publishes clinical and experimental studies in fields related to thoracic and cardiovascular surgery.