Off-pump coronary artery bypass grafting in octogenarians

Shimokawa, Tomoki; Minato, Naoki; Yamada, Noriko; Takeda, Yuji; Hisamatsu, Yasushi; Itoh, Masatoshi

doi:10.1007/s11748-003-0078-4

Cited by 14 publications

(18 citation statements)

References 13 publications

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“…In addition, not all the studies adjusted their data with propensity score matching analysis or multivariable analysis. For example, the RCT by Diegeler et al (10) used multivariate models that incorporated clinical predictors to estimate the operative mortality, whereas the non-RCT study by Lin et al (20 ) reported data based on unadjusted variables. Some non-RCTs, such as by Sarin et al (15), provided propensity-adjusted, retrospective review of their patient data.…”

Section: Discussionmentioning

confidence: 99%

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

Zhu

Xiong

Ding

et al. 2017

Braz J Med Biol Res

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The aim of this study was to analyze if off-pump coronary artery bypass surgery (CABG) is associated with better treatment outcomes in elderly patients (>70 years of age) than on-pump CABG, using meta-analysis. Medline, PubMed, Cochrane and Google Scholar databases were searched until September 13, 2016. Sensitivity and quality assessment were performed. Twenty-two studies, three randomized control trials (RCTs) and 20 non-RCTs were included with 24,127 patients. The risk of death associated with on-pump or off-pump CABG in the RCTs were similar (pooled OR=0.945, 95%CI=0.652 to 1.371, P=0.766). However, in the non-RCTs, mortality risk was lower in patients treated with off-pump CABG than on-pump CABG (pooled OR=0.631, 95%CI=0.587 to 0.944, P=0.003). No differences were observed between the two treatment groups in terms of the occurrence of 30-day post-operative stroke or myocardial infarction (P≥0.147). In the non-RCTs, off-pump CABG treatment was associated with a shorter length of hospital stay (pooled standardized difference in means=-0.401, 95%CI=-0.621 to -0.181, P≤0.001). The meta-analysis with pooled data from non-RCTs, but not RCTs, found that mortality was lower with off-pump compared with on-pump CABG, and suggested that there may be some benefit of off-pump CABG compared with on-pump CABG in the risk of mortality and length of hospital stay.

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Section: Discussionmentioning

confidence: 99%

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

Zhu

Xiong

Ding

et al. 2017

Braz J Med Biol Res

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“…Several meta-analyses 30 (22) Ricci (15) Ascione (23) Meharwal (16) Subtotal (95% CI) Total events: 30 (OPCAB), 87 (CPB) Test for heterogeneity: χ 2 = 3.51, df = 3 (p = 0.32), I 2 = 14.6% Test for overall effect: Z = 0.31 (p = 0.76) 02 > 75 years old Koutlas (19) Al-Ruzzeh (18) Hirose (17) Deuse (12) Subtotal (95% CI) Total events: 6 (OPCAB), 33 (CPB) Test for heterogeneity: χ 2 = 5.74, df = 3 (p = 0.12), I 2 = 47.6% Test for overall effect: Z = 1.02 (p = 0.31) 03 > 80 years old Demaria (20) Hoff (21) Beauford (8) Lin (9) Shimokawa (11) D'Alfonso (10) Subtotal (95% CI) (0.28 to Figure 1 Comparison between off-pump coronary artery bypass (OPCAB) and on-pump cardiopulmonary bypass (CPB) in the elderly: postoperative mortality stratified by age (random effects model). CI, confidence interval; OR, odds ratio.…”

Section: Discussionmentioning

confidence: 99%

“…CI, confidence interval; OR, odds ratio. (22) Ricci (15) Ascione (23) Meharwal (16) Subtotal (95% CI) Total events: 110 (OPCAB), 72 (CPB) Test for heterogeneity: χ 2 = 15.05, df = 3 (p = 0.002), I 2 = 80.1% Test for overall effect: Z = 0.07 (p = 0.94) 02 age > 75 years Koutlas (19) Al-Ruzzeh (18) Hirose (17) Subtotal (95% CI) Total events: 2 (OPCAB), 15 (CPB) Test for heterogeneity: χ 2 = 1.83, df = 2 (p = 0.40), I 2 = 0% Test for overall effect: Z = 1.94 (p = 0.05) 03 age > 80 years Demaria (20) Hoff (21) Lin (9) Shimokawa (11) D'Alfonso (10) Subtotal (95% CI) (22) Koutlas (19) Al-Ruzzeh (18) Ascione (23) Demaria (20) Hoff (21) Meharwal (16) Lin (9) Shimokawa (11) D'Alfonso (10) Total (95% Cl) Total events: 161 (OPCAB), 383 (CPB) Test for heterogeneity: χ 2 = 9.10, df = 9 (p = 0.43), I 2 Figure 3 Comparison between off-pump coronary artery bypass (OPCAB) and on-pump cardiopulmonary bypass (CPB) in the elderly: postoperative atrial fibrillation stratified by age (random effects model). CI, confidence interval; OR, odds ratio.…”

Section: Discussionmentioning

confidence: 99%

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Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass grafting--comparison between off-pump and on-pump techniques

Panesar

Athanasiou

Nair

et al. 2006

Heart

111

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“…Following exclusion of one article where the full text was in Japanese (28), 18 articles were deemed suitable and met the inclusion criteria listed above. All 18 studies were retrospective studies (2,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Five studies (38,40,(42)(43)(44) presented propensity-matched comparison of the 2 cohorts.…”

Section: Resultsmentioning

confidence: 99%

Off-pump coronary artery bypass grafting in octogenarians

Raja¹

2016

J. Thorac. Dis.

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Enhanced life expectancy has confronted cardiac surgery with a rapidly growing population of octogenarians needing coronary artery bypass grafting (CABG). Octogenarians are deemed a high-risk patient population with increased postoperative morbidity and mortality following conventional CABG using cardiopulmonary bypass (CPB). In such patients reducing the invasiveness of the surgical procedure by avoiding CPB may be tried in an attempt to improve outcomes. The increasing performance of off-pump coronary artery bypass (OPCAB) grafting within certain centers reflects surgeon preference to avoid the inherent risks of CPB and cardioplegic arrest including hemodilution, nonpulsatile arterial flow, global myocardial ischemia, atherosclerotic embolization from aortic manipulation, and systemic inflammatory response. Although OPCAB grafting is a well-established surgical myocardial revascularization strategy, its actual benefits in terms of morbidity and mortality remain questionable in the general population. In the higher risk octogenarian patients, however, there is a potential for more tangible clinical benefits when CPB is avoided. This review article provides an overview of the impact of OPCAB grafting on postoperative mortality and morbidity in octogenarians.

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Off-pump coronary artery bypass grafting in octogenarians

Abstract: Off-pump CABG is thus a safe and effective for myocardial revascularization in the elderly.

Cited by 14 publications

References 13 publications

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

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

Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass grafting--comparison between off-pump and on-pump techniques

Off-pump coronary artery bypass grafting in octogenarians

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