On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction: A Propensity-Score Matched Analysis From the ANZSCTS Database

Zhu, Michael Z.L.; Huq, Molla; Billah, Baki; Tran, Lavinia; Reid, Christopher M.; Varatharajah, Kapilan; Rosenfeldt, Franklin

doi:10.1016/j.hlc.2018.06.1051

Cited by 9 publications

(25 citation statements)

References 25 publications

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“…A recent review of the ANZSCTS Database showed that OPBHC accounts for only 1.3% of the surgical revascularizations, with a mean range of 1 to 16 OPBHC procedures per year in Australia. 13 Conversely, in other countries the OPBHC approach reaches 24% of all CABG procedures 14 with reported better results. [15][16][17] The reasons rely on surgical expertise, patient comorbidities, and patient clinical status.…”

Section: Resultsmentioning

confidence: 98%

“…Scientific evidence on the topic derives from retrospective observational studies mainly focused on high-risk patients. Literature search yielded a total of 279 records, and 17 studies 7,10,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28] and two meta-analyses 29,30 published between 2000 and 2020 were finally included in the systematic review (PRISMA flow diagram, Figure 1). Quality assessment is shown in Table 2; study characteristics and collected outcomes are summarized in Tables 3 and 4 and described below.…”

Section: Resultsmentioning

confidence: 99%

“…OPBHC technique is an effective method to perform surgical myocardial revascularization in high-risk patients. 10,13,[16][17][18][20][21][22][24][25][26][27][28] Elective use of OPBHC can be considered as a measure to prevent the hemodynamic deterioration and guarantee adequate end-organ (Table 7).…”

Section: Discussionmentioning

confidence: 99%

“…Urgent CABG performed early after acute MI carries a higher risk of mortality compared with percutaneous procedures, but is necessarily indicated in case of failure/complications of percutaneous strategies, unfavorable coronary anatomy for percutaneous coronary intervention (PCI) or persistent myocardial ischemia refractory to medical or percutaneous therapy. 13,28,31,32 However, a recently infarcted myocardium poorly tolerates the additional insult of cardioplegic arrest and ischemia-reperfusion syndrome 13,32 ; those factors might deteriorate cardiac function leading to suboptimal clinical outcomes. 13,32 Maintaining a beating-heart translates into reduced myocardial ischemia and improved function.…”

Section: Discussionmentioning

confidence: 99%

“…13,28,31,32 However, a recently infarcted myocardium poorly tolerates the additional insult of cardioplegic arrest and ischemia-reperfusion syndrome 13,32 ; those factors might deteriorate cardiac function leading to suboptimal clinical outcomes. 13,32 Maintaining a beating-heart translates into reduced myocardial ischemia and improved function. 17 Off-pump CABG avoids CPB, cardioplegic arrest and aortic crossclamping, but carries higher risks in patients with hemodynamic instability or frequent arrhythmias; adequate perfusion can require higher doses of inotropes or vasopressors, with potential end-organ damage.…”

Section: Discussionmentioning

confidence: 99%

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On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

et al. 2020

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Background Operative technique for surgical myocardial revascularization in high‐risk patients remains an argument of debate. On‐pump coronary artery bypass graft (CABG) with cardioplegic arrest and off‐pump CABG have intrinsic limitations. The hybrid approach of on‐pump beating‐heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta‐analysis intends to summarize the contemporary literature. Methods A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study. Results Compared with on‐pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36‐0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39‐0.91). Also, interesting trends towards reduced postoperative intra‐aortic balloon pump use (RR, 0.56, 95% CI, 0.31‐1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22‐1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off‐pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off‐pump CABG (RR, 0.53, 95% CI, 0.33‐0.87) but higher than conventional on‐pump CABG (RR, 1.71, 95% CI, 1.23‐2.39). Conclusion OPBHC is an effective technique to perform surgical revascularization in high‐risk patients as preventing haemodynamic deterioration and guaranteeing adequate end‐organ perfusion. OPBHC represents an alternative technique to on‐pump and off‐pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

et al. 2020

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On and Off Pump: The Marriage of Opposites With Potential Long-Term Rewards

Gamel

Cochrane

2019

Heart, Lung and Circulation

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Coronary artery bypass surgery for acute coronary syndrome: A network meta‐analysis of on‐pump cardioplegic arrest, off‐pump, and on‐pump beating heart strategies

Hwang

Williams

Tian

et al. 2022

Journal of Cardiac Surgery

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Background Coronary artery bypass grafting (CABG) in the setting of an acute coronary syndrome is a high‐risk procedure, and the best strategy for myocardial revascularisation remains debated. This study compares the 30‐day mortality benefit of on‐pump CABG (ONCAB), off‐pump CABG (OPCAB), and on‐pump beating heart CABG (OnBHCAB) strategies. Methods A systematic search of three electronic databases was conducted for studies comparing ONCAB with OPCAB or OnBHCAB in patients with acute coronary syndrome (ACS). The primary outcome, 30‐day mortality, was compared using a Bayesian hierarchical network meta‐analysis (NMA). A random effects consistency model was applied, and direct and indirect comparisons were made to determine the relative effectiveness of each strategy on postoperative outcomes. Results One randomised controlled trial and eighteen observational studies fulfilling the inclusion criteria were identified. A total of 4320, 5559, and 1962 patients underwent ONCAB, OPCAB, and OnBHCAB respectively. NMA showed that OPCAB had the highest probability of ranking as the most effective treatment in terms of 30‐day mortality (odds ratio [OR], 0.50; 95% credible interval [CrI], 0.23−1.00), followed by OnBHCAB (OR, 0.62; 95% CrI, 0.20−1.57), however the 95% CrI crossed or included unity. A subgroup NMA of nine studies assessing only acute myocardial infarction (AMI) patients demonstrated a 72% reduction in likelihood of 30‐day mortality after OPCAB (CrI, 0.07−0.83). No significant increase in rate of stroke, renal dysfunction or length of intensive care unit stay was found for either strategy. Conclusions Although no single best surgical revascularisation approach in ACS patients was identified, the significant mortality benefit with OPCAB seen with AMI suggests high acuity patients may benefit most from avoiding further myocardial injury associated with cardiopulmonary bypass and cardioplegic arrest.

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On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction: A Propensity-Score Matched Analysis From the ANZSCTS Database

Cited by 9 publications

References 25 publications

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

On and Off Pump: The Marriage of Opposites With Potential Long-Term Rewards

Coronary artery bypass surgery for acute coronary syndrome: A network meta‐analysis of on‐pump cardioplegic arrest, off‐pump, and on‐pump beating heart strategies

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