Comparison of Outcomes Between Total Arterial Off-Pump Versus On-Pump Coronary Artery Bypass Surgery: A Meta-Analysis and Meta-Regression

An essential aspect of achieving early optimal outcomes in coronary artery bypass grafting (CABG) is the careful selection of conduits. Total arterial grafting (TAG) has been debated, and recent studies suggest its benefits, especially when combined with off-pump coronary artery bypass grafting (OPCAB). We conducted a systematic review and meta-analysis of studies comparing outcomes of TAG in OPCAB versus on-pump CABG (ONCAB), using data from OVID MEDLINE, EMBASE, SCOPUS, and PUBMED. Seven studies with a total of 5417 patients were included. Short-term outcomes showed no significant differences in perioperative complications between TAG-OPCAB and TAG-ONCAB, but TAG-OPCAB was associated with reduced short-term mortality (OR 0.48, 95% CI [0.26, 0.89], p = 0.02), lower incidence of postoperative low cardiac output, atrial fibrillation, and MACCEs, as well as shorter intubation duration and hospital stay. Meta-regression did not reveal any associations between pre- or intraoperative variables and short-term mortality. In conclusion, TAG-OPCAB demonstrates favorable short-term outcomes and may be considered a safe and effective strategy in selected patients, while long-term outcomes remain inconclusive due to limited data.