On-pump versus off-pump coronary artery bypass graft surgery. What do the evidence show?

Rodrigues, Alfredo José; Évora, Paulo Roberto Barbosa; Tubino, Paulo

doi:10.5935/1678-9741.20130086

Cited by 7 publications

(7 citation statements)

References 50 publications

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“…Despite the continuous evolution, CPB has potential harm as a result of physiological processes and can result in tissue damage and organ dysfunction. As the interest for OPCABG has been gradually increasing, several concerns have been raised and authors are still trying to answer if OPCABG reduces hospital morbidity and mortality, if OPCABG has the same outcomes especially regarding security, long-term survival and quality of grafts and if it is possible to perform the full revascularization using OPCABG [12].…”

Section: Discussionmentioning

confidence: 99%

Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience

Carmona

Paredes

Mateo

et al. 2016

Interact CardioVasc Thorac Surg

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Section: Discussionmentioning

confidence: 99%

Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience

Carmona

Paredes

Mateo

et al. 2016

Interact CardioVasc Thorac Surg

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“…Studies show different conclusions regarding the results found when the techniques compared with and without cardiopulmonary bypass [ 21 , 23 ] . On the other hand, several investigators have indicated that off-pump CABG surgery may increase the risk of thrombosis due to augmented thrombotic activity [ 24 , 25 ] .…”

Section: Discussionmentioning

confidence: 99%

Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate

Prates¹,

Williams²,

Mehta³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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IntroductionAntiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario.ObjectiveIdentify predictors of clopidogrel following CABG.MethodsWe evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG.ResultsAt hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032).ConclusionClopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.

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“…8 The literature is rich in studies comparing OPCAB versus on-pump CABG with controversial results, showing either improved outcomes or no significant difference between the two procedures. 9 10 11 12 13 These results have led surgeons to appraise whether or not off-pump surgery may be specifically beneficial for high-risk patient groups. 11 14 15 However, few studies directly compare the two techniques in PAD patients undergoing CABG, some of which are biased by imbalances in patient characteristics.…”

Section: Introductionmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Reduces Cardiac Death in Patients with Peripheral Arteriopathy

Bonacchi

Howe

Micali

et al. 2021

Thorac Cardiovasc Surg

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Objective The aim of this study was to investigate whether the use of off-pump coronary artery bypass (OPCAB) may enhance early outcomes in subjects with peripheral artery disease (PAD) undergoing coronary artery bypass grafting (CABG). Methods We employed a propensity-score (PS) method to compare early postoperative results of OPCAB and on-pump CABG patients with associated PAD. The study population consisted of 1,961 patients: 284 in the OPCAB and 1,677 in the on-pump CABG group. The inverse probability of treatment weighting was used as PS method. Results The incidence of death (1.2% [95% confidence interval, CI: –0.9 to 3.3%], p = 0.262), stroke (2.2% [95% CI: –1.4 to 5.7%], p = 0.235), acute kidney disease (1.5% [95% CI: –3.8 to 6.8%], p = 0.586), limb ischemia (3.2% [95% CI: –0.6 to 7.0%], p = 0.315), and low output syndrome (1.2% [95% CI: –0.9 to 3.3%], p = 0.262) did not differ between the two groups. On the other hand, the rate of cardiac death (1.2% [95% CI: –0.1 to 2.3%], p = 0.038) was significantly higher in on-pump CABG group. Conclusions The OPCAB procedure considerably reduced the occurrence of cardiac death after coronary revascularization. This finding might suggest that the OPCAB procedure should be considered as the first option in patients with higher cardiovascular risk scores. Further research is warranted.

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On-pump versus off-pump coronary artery bypass graft surgery. What do the evidence show?

Cited by 7 publications

References 50 publications

Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience

Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience

Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate

Off-Pump Coronary Artery Bypass Reduces Cardiac Death in Patients with Peripheral Arteriopathy

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