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

Abstract

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.

Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization

“…Despite some disadvantages, the off-pump technique still possesses a profound protective value in high-risk patients [ 44 , 45 ]. The main advantage of surgical revascularization is the time-related long-term survival rate [ 46 ]. Despite its invasive nature, the surgery gives superior results and places the surgical procedure as the optimal treatment for complex coronary artery disease [ 47 – 49 ] especially with ulitity of arterial grafts [ 50 , 51 ].…”

Coronary artery bypass grafting in left ventricular dysfunction: when and how

“…Patients undergoing OPBH showed a preoperative higher risk profile, 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) when compared with traditional CABG. Comparison with off-pump showed same baseline characteristics and postoperative complications, but the risk of incomplete revascularization in OPBH was lower than off–pump CABG (RR 0.53, 95% CI 0.33–0.87) but higher than conventional CABG (RR 1.71, 95% CI 1.23–2.39) [38].…”

Validation of Various Prediction Scores for Cardiac Surgery-Associated Acute Kidney Injury

“…This study showed that patients who underwent CABG on pump-beating heart surgery are more likely to develop AKI than in other types of cardiac surgery. It is difficult to explain such results but the fact that on-pump beating-heart CABG (OPBHC) is usually used in high-risk patients in which off-pump CABG cannot be utilized due to hemodynamic deterioration and adequate end-organ perfusion can’t be achieved which may explain such result [ 32 ]. Furthermore, OPBHC is an alternative to on-pump CABG in which complications from cardioplegic arrest or manipulation of the heart are anticipated [ 32 ].…”