Efficacy and effectiveness of on- versus off-pump coronary artery bypass grafting: A meta-analysis of mortality and survival

Abstract

Evidence from RCTs showed no differences between the techniques, whereas rigorously adjusted observational studies (with >1.1 million patients) and the combined analysis indicated that off-pump CABG offers lower short-term mortality but poorer long-term survival. These results suggest that, in real-world settings, greater operative safety with off-pump CABG comes at the expense of lasting survival gains.

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…However, a recently published RCT (n=2932 patients) demonstrated that OPCAB reduced the risk of postoperative AKI in comparison to on‐pump coronary artery bypass grafting, with no discernable difference in kidney function at 1 year . Although data suggest a reduction in AKI in OPCAB, a recent RCT and several meta‐analyses have demonstrated an increase in long‐term, all‐cause mortality in OPCAB compared with on‐pump surgery. Consequently, the greater operative safety and possible prevention of AKI with OPCAB may come at the expense of long‐term survival gains.…”

Acute kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: a retrospective propensity score matching analysis

“…However, whether off-pump technique could improve the outcome of CABG is still a controversial issue, and many studies have compared outcomes between onpump and off-pump technique. In general, there is a higher proportion of AKI in the on-pump group than in the off-pump group [7,8] , but no signi cant differences with regard to the outcomes of mortality and renal failure [7,9,10] . These results manifested that postoperative AKI in the on-pump CABG did not translate to adverse outcomes, which con icted with results from the literature conducted previously.…”

Off- vs. On-Pump Coronary Artery Bypass Grafting Long-Term Survival is Driven by Incompleteness of Revascularisation

“…Off-pump CABG is also considered a technically more challenging procedure that requires significant operator experience [6]. Randomised trials comparing onversus off-pump CABG are conflicting [7,8], while previous meta-analyses including observational studies report contrasting outcomes of benefit and risk [5,[9][10][11][12]. The most recent pooled analysis of randomised trials at long-term follow-up demonstrated statistical superiority for the on-pump approach [13], but provided no clear mechanism for the survival benefit observed.…”