Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

Abstract

Abstract:The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass grafting (CABG) remains unclear despite a large body of literature evidence comparing the two approaches.The potential advantages of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation and maintaining pulsatile flow may be associated with reduced inflammatory responses and embolic events.Numerous studies compared OPCAB with ONCAB and the cumulative data have been presented in metaanalyses of both randomized and observational studies. Although there is an abundance of data with respect to the operative morbidity and mortality and the short-term outcomes associated with these two strategies, not much is known about how they impact long-term survival and recurrence of myocardial ischaemic events. Recent studies and meta-analyses have focused on long-term survival and major secondary outcomes in OPCAB vs. ONCAB within the general population. Significant limitations in methodology, however, have raised concerns about the strength of several randomized trials with restrictive inclusion criteria that reduced the populations to those at low risk only, thus creating result bias. Here, we present a review of the best available evidence with a focus on long-term outcomes.

Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting

“…This meta-analysis concentrated on prospective RCTs; however there been other large retrospective studies that have investigated long term survival. On the whole, these studies have shown no difference in mortality between off pump and on pump CABG [18]. In the 2 exceptions long-term survival rates were significantly better in the on pump group.…”

Comparative effects of off-pump and multiple cardiopulmonary bypass strategies in coronary artery bypass grafting surgery: protocol for a systematic review and network meta-analysis

“…2 For decades, the heart is typically arrested with cardioplegia undergoing cardiopulmonary bypass (CPB) to ensure a bloodless surgical field for CABG. 3 However, this conventional on-pump CABG (ONCAB) is often associated with potentially negative effects, including activation of systemic inflammatory responses, excessive haemodilution, haemodynamic instability and risk of air embolism or atherosclerotic debris. These adverse events often lead to subsequent multiorgan dysfunction.…”

Postoperative Neutrophil to Lymphocyte Ratio as an Overall Mortality Midterm Prognostic Factor following OPCAB Procedures

“…Off-pump surgical revascularization of complex coronary artery disease has gained worldwide attention [ 2 , 3 , 4 ]. The major advantage of off-pump coronary artery bypass grafting (OPCAB) consists in the avoidance of non-physiological blood flow and minimization of the risk of complications related to inflammatory response.…”