Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Zhu, Zhengming; Xiong, Wei; Ding, J.L.; Chen, J.; Li, Y.; Zhou, Jingran; Xu, Jiasheng

doi:10.1590/1414-431x20165711

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…The results of this study were in line with Z.G. Zhu et al revealed that the patients undergoing on-pump CABG surgery had longer length of hospital stay compared with the cases undergoing off-pump CABG surgery (P=0.001) (18).…”

Section: Discussionsupporting

confidence: 90%

A survival after coronary artery bypass grafting surgery with ejection fraction below 30 percent

2018

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Introduction: Regarding the progress in surgeries, the mortality rate of coronary artery bypass grafting surgery is still low, despite advanced age and comorbidities. One of the independent causes of mortality rate is low ejection fraction (EF). This study aimed to assess mortality after coronary artery bypass grafting (CABG) operation in patients with ejection fraction under 30%. In the present study the experience of 20 patients with an EFbelow 30% and 20 patients with an EF above 30% was investigated in Birjand in which only three of the patients died within 2 years after the operation. Methods: This crross-sectional descriptive study was conducted on 40 patients in Birjand Vali-e-aser Hospital. Out of the 40 cases, 20 patients had EF below 30% and 20 subjects had EF above 30 %. The files of all the cases undergoing heart surgery with an EF were obtained since 2015 to 2017, and then their demographic features, such as addresses and phone numbers were collected. Afterwards, they were called and their mortality was checked and the data were analyzed with independent-samples t-test. In addition, the ratios were examined in SPSS Software (version 22) and P-value considered higher than 0.05. Results: From 2015 to 2017, the two groups, including 20 patients with EF<30% and 20 patients with EF>30%, undergone CABG surgery in Birjand University of Medical Science, 65% of which were men and 35 % were women with the age range of 64.7 for the cases with EF<30 and 62.5 for the subjects EF>30. One of the patients died with an EF above 30% and two subjects died with EF below 30%. Conclusions: The mortality rate can be reduced with providing appropriate care despite the fact that an EF<30% is an independent cause of mortality and according to the results of the present study which showed three patients died after the CABG operation.

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Section: Discussionsupporting

confidence: 90%

A survival after coronary artery bypass grafting surgery with ejection fraction below 30 percent

2018

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“…off-pump CABG in patients with age of >70 or >80 years. The results are contradictory, e.g ., Altarabsheh et al [ 11 ] found higher rates of stroke following on-pump surgery, whilst Panesar et al [ 12 ] and Zhu et al [ 13 ] found comparable rates. Although elderly people represent an important subset of patients, there is a much broader age range of patients undergoing on- or off-pump CABG.…”

Section: Introductionmentioning

confidence: 99%

Effect of Age on Clinical Outcomes Following On-/Off-Pump Coronary Artery Bypass: MetaAnalysis and Meta-Regression

Mauldon¹,

Dieberg²,

Smart³

et al. 2020

Braz J Cardiovasc Surg

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Objective There is currently much debate about which patients would benefit more after on- or off-pump coronary artery bypass grafting (CABG). The aim of this meta-analysis and meta-regression is to investigate the effect of age on short-term clinical outcomes after these approaches. Methods To identify potential studies, systematic searches were carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy included the key concepts of “cardiopulmonary bypass” AND “coronary artery bypass grafting” AND “off pump” OR “on pump”. This was followed by a meta-analysis and meta-regression investigating the effect of age on the incidences of stroke, myocardial infarction (MI), and mortality. Results Thirty-seven studies including 15,324 participants were analysed. Overall, there was a significant odds reduction for patients receiving off-pump CABG suffering a stroke (odds ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P =0.048); however, when patients were subdivided according to different age bands, this difference disappeared. There were also no significant differences in the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P =0.241) or MI (OR 0.937, 95% CI 0.795, 1.105, P =0.439). Meta-regression analysis revealed no significant relationship between age and stroke ( P =0.652), age and mortality ( P =548), and age and MI ( P =0.464). Conclusion Patients undergoing CABG are becoming older and may suffer from multiple comorbidities increasing their risk profile. However, with respect to short-term clinical outcomes, the patient’s age does not help in determining whether off- or on-pump is superior.

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“…It may be time, however, to focus on identifying which patients benefit from which procedure, i.e., offpump CABG is probably better for some patients and on-pump CABG for others (9). For example, off- pump CABG may be superior for elderly patients (10), octogenarians (11), and patients with chronic kidney disease (CKD) (12). First, in a meta-analysis (10) of 3 RCTs and 20 non-RCTs with a total of 12,697 ≥70-year patients, there was a reduced chance of overall mortality (from 30-day to 10-year follow-up) in patients who received off-pump CABG compared with on-pump CABG (pooled OR, 0.744; 95% CI, 0.587-0.944; P=0.015).…”

Section: Editorialmentioning

confidence: 99%

The lion and the unicorn were fighting for the crown: on-pump versus off-pump coronary-artery bypass grafting

2017

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Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Cited by 5 publications

References 32 publications

A survival after coronary artery bypass grafting surgery with ejection fraction below 30 percent

A survival after coronary artery bypass grafting surgery with ejection fraction below 30 percent

Effect of Age on Clinical Outcomes Following On-/Off-Pump Coronary Artery Bypass: MetaAnalysis and Meta-Regression

The lion and the unicorn were fighting for the crown: on-pump versus off-pump coronary-artery bypass grafting

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