151. Off- Versus On-Pump Coronary Surgery and the Effect of Follow-Up Length and Surgeons' Experience:A Meta-Analysis
- Author
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Gianni D Angelini, David P. Taggart, Adham Elmously, Ahmed Abouarab, Antonino Di Franco, Leonard N. Girardi, Jeremy R. Leonard, Umberto Benedetto, Mohamed Rahouma, Mario Gaudino, Stephen E. Fremes, Derrick Y. Tam, Faisal G. Bakaeen, and John D. Puskas
- Subjects
medicine.medical_specialty ,Myocardial revascularization ,off‐pump surgery ,medicine.medical_treatment ,coronary artery bypass grafting ,Coronary Artery Bypass, Off-Pump ,Coronary artery bypass ,Coronary surgery ,Coronary artery bypass grafting ,030204 cardiovascular system & hematology ,Revascularization ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Off-pump surgery ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Off-pump coronary artery bypass grafting ,Coronary Artery Bypass ,Surgeons ,Cardiovascular Surgery ,Systematic Review and Meta‐analysis ,business.industry ,off‐pump coronary artery bypass grafting ,myocardial revascularization ,Centre for Surgical Research ,Meta-analysis ,Cardiology ,revascularization ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background The debate on the relative benefits of off‐pump and on‐pump coronary artery bypass surgery (OPCABG and ONCABG) is still open. We aimed to provide an updated and complete summary of the evidence on the differences between OPCABG and ONCABG and to explore whether the length of the follow‐up and the surgeons’ experience in OPCABG modify the comparative results. Methods and Results All randomized clinical trials comparing OPCABG and ONCABG were included. Primary outcome was follow‐up mortality. Secondary outcomes were operative mortality, perioperative stroke, perioperative myocardial infarction, and late repeated revascularization. Subgroup analyses were performed based on the length of the follow‐up and the percentage of crossover from the OPCABG group (used as a surrogate of surgeon experience with OPCABG). One hundred four trials were included (20 627 patients, OPCABG: 10 288; ONCABG: 10 339). Weighted mean follow‐up time was 3.7 years (range 1–7.5 years). OPCABG was associated with a higher risk of follow‐up mortality (incidence rate ratio 1.11, 95% confidence interval 1.00–1.23, P=0.05). The difference was significant only for trials with mean follow‐up of ≥3 years and for studies with a crossover rate of ≥10%. There was a trend toward lower risk of perioperative stroke and higher need for late repeated revascularization in the OPCABG arm. Conclusions OPCABG is associated with a higher incidence of incomplete revascularization, an increased need for repeated revascularization, and decreased midterm survival compared with ONCABG. Surgeon inexperience in OPCABG is associated with late mortality., See Editorial by Lazar
- Published
- 2018