Short-term outcomes of off-pump vs. on-pump coronary artery bypass grafting in left main coronary artery disease: a systematic review and meta-analysis.
Lucas Nogueira Pansani, Pedro Emanuel de Paula Carvalho, Douglas Gewehr, Maurizio Taramasso, Giullia Burkhardt, Lara Almeidinha, Rafael Ayala, Martin Tobias Robert Grapow
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引用次数: 0
Abstract
Background: The efficacy and safety of off-pump relative to on-pump coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) remain unclear.
Objectives: Conduct a meta-analysis assessing the outcomes following CABG comparing off-pump CABG vs. on-pump CABG.
Methods: MEDLINE, Cochrane, and Embase were examined for randomized controlled trials (RCTs) and observational studies that communicated outcomes after off-pump vs. on-pump CABG in patients with LMCAD. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Cochrane recommendations for quality assessment and risk of bias were performed. This study was registered in the PROSPERO platform, ID: CRD42023451467.
Results: One RCT and 17 observational studies with 16,848 patients were included, 6735 (40.0%) of whom underwent off-pump CABG. In patients with LMCAD undergoing CABG, off-pump CABG was associated with a lower incidence of all-cause mortality (OR 0.52, 95% CI 0.38-0.71; p < 0.001), acute renal dysfunction (OR 0.40; 95% CI 0.27-0.59; p < 0.001), postoperative use of intra-aortic balloon pump (IABP) (OR 0.38; 95% CI 0.22-0.64; p < 0.01), and wound infection (OR 0.66; 95% CI 0.48-0.9; p = 0.01). There was no difference between the groups for myocardial infarction (OR 0.81; 95% CI 0.59-1.11; p = 0.193), stroke, or transitional ischemic attack (TIA) (OR 0.64; 95% CI 0.38-1.06; p = 0.085). The number of grafts per patient was also lower in the off-pump CABG group (mean deviation (MD) -0.32; 95% CI -0.50 to -0.14; p < 0.001). After a mean follow-up of 38.1 months, no significant difference in all-cause mortality incidence was observed between the two techniques (OR 0.72; 95% CI 0.30-1.74; p = 0.47). This underscores that the reduction in mortality rates was primarily driven by short-term outcomes.
Conclusion: In this meta-analysis with 16,848 patients with LMCAD undergoing CABG, off-pump CABG was associated with lower rates of all-cause mortality, acute renal dysfunction, IABP use, and wound infection compared with on-pump CABG.
Graphical abstract: On-pump versus off-pump CABG in patients with LMCAD.
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-01907-w.
背景：相对于左主干冠状动脉疾病（LMCAD）患者的非体外循环冠状动脉旁路移植术（CABG）的有效性和安全性尚不清楚。目的：进行荟萃分析，比较非泵送式冠脉搭桥与泵送式冠脉搭桥后的结果。方法：MEDLINE、Cochrane和Embase对随机对照试验（rct）和观察性研究进行了检查，这些研究交流了LMCAD患者停泵与停泵CABG后的结果。95%置信区间（CI）的优势比（OR）与随机效应模型合并。采用Cochrane关于质量评估和偏倚风险的建议。本研究在PROSPERO平台注册，ID: CRD42023451467。结果：纳入1项随机对照试验和17项观察性研究，共16,848例患者，其中6735例（40.0%）接受了体外循环CABG。在接受冠脉搭桥的LMCAD患者中，非泵血冠脉搭桥与较低的全因死亡率相关(OR 0.52, 95% CI 0.38-0.71；p p p p = 0.01)。两组间心肌梗死发生率无差异(OR 0.81；95% ci 0.59-1.11；p = 0.193)、中风或过渡性脑缺血发作（TIA） (or 0.64；95% ci 0.38-1.06；p = 0.085)。非泵送CABG组每位患者的移植物数量也较低(平均偏差(MD) -0.32；95% CI -0.50 ~ -0.14；p = 0.47)。这突出表明，死亡率的降低主要是由短期结果推动的。结论：在这项对16,848例接受CABG的LMCAD患者进行的荟萃分析中，与有泵CABG相比，无泵CABG与全因死亡率、急性肾功能障碍、IABP使用和伤口感染相关。图形摘要：LMCAD患者的开泵与停泵CABG。补充信息：在线版本包含补充资料，提供地址为10.1007/s12055-025-01907-w。
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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