A systematic review and meta-analysis of randomized controlled studies comparing off-pump versus on-pump coronary artery bypass grafting in the elderly

• Type: Article in International Scientific Journal
• Date: 2022

Authors

Machado, RJ (Author) Other; Saraiva, FA (Author) Other; Mancio, J (Author) FMUP; Sousa, P (Author) Other; Cerqueira, RJ (Author) Other; Barros, AS (Author) Other; Andre P Lourenco (Author) FMUP; Leite Moreira, AF (Author) Other

Journal

Title: Journal of Cardiovascular Surgery

Vol. 63

Pages: 60-68

ISSN: 0021-9509

Publisher: EDIZIONI MINERVA MEDICA

Indexing

ISI Web of Knowledge - 5 Citations

Other information

Authenticus ID: P-00W-9NY

DOI: 10.23736/s0021-9509.21.12012-9

Abstract (EN): INTRODUCTION: Comparison of short and mid-term outcomes between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) in patients older than 65 throughout a meta-analysis of randomized clinical trials (RCTs). EVIDENCE ACQUISITION: A literature search was conducted using 3 databases. RCTs reporting mortality outcomes of OPCAB versus ONCAB among the elderly were included. Data on myocardial infarction, stroke, re-revascularization, renal failure and composite endpoints after CABG were also collected. Random effects models were used to compute statistical combined measures and 95% confidence intervals (CI). EVIDENCE SYNTHESIS: Five RCTs encompassing 6221 patients were included (3105 OPCAB and 3116 ONCAB). There were no significant differences on mid-term mortality (pooled HR: 1.02, 95%CI: 0.89-1.17, P=0.80) and composite endpoint incidence (pooled HR: 0.98, 95%CI: 0.88-1.09, P=0.72) between OPCAB and ONCAB. At 30-day, there were no differences in mortality, myocardial infarction, stroke and renal complications. The need for early re-revascularization was significantly higher in OPCAB (pooled OR: 3.22, 95%CI: 1.28-8.09, P=0.01), with a higher percentage of incomplete revascularization being reported for OPCAB in trials included in this pooled result (34% in OPCAB vs. 29% CONCLUSIONS: Data from RCTs in elderly patients showed that OPCAB and ONCAB provide similar mid-term results. OPCAB was associated with a higher risk of early re-revascularization. As CABG on the elderly is still insufficiently explored, further RCTs, specifically designed targeting this population, are needed to establish a better CABG strategy for these patients. (Cite this article as: Machado RJ, Saraiva FA, Mancio J, Sousa P, Cerqueira RJ, Barros AS, et al. A systematic review and meta-analysis of randomized controlled studies comparing off-pump versus on-pump coronary artery bypass grafting in the elderly. J Cardiovasc Surg 2022;63:60-8. DOI:

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9