Does Off-pump Coronary Artery Bypass Confer any Advantage in Patients with End-stage Renal Failure? A Systematic Review and Meta-analysis

Ju Yong Lim, Salil V. Deo, Sung Ho Jung, Salah E. Altarabsheh, Patricia J. Erwin, John J. Dillon, Soon J. Park

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: Patients with end-stage renal disease (ESRD) are often excluded from trials comparing off and on-pump coronary artery bypass grafting (CABG). Thus data in this cohort is limited to small retrospective studies. Hence we compared the adverse clinical events and outcome in patients with ESRD undergoing off (OPCABG) and on-pump surgery (ONCABG). Methods: Pubmed, Scopus and Web of Science were searched (inception - June 2013) to identify studies comparing clinical results of OPCABG and ONCABG in dialysis dependent patients. A random effect inverse variance weighted meta-analysis was conducted. Results are presented as risk ratios (RR) with 95% confidence intervals; p. <. 0.05 is significant. Result: Ten retrospective studies (2762 OPCABG and 11310 ONCABG) fulfilled criteria and were pooled. Patients undergoing off-pump surgery were less than 100 in most of the articles. Early mortality [OPCABG (8.4%); ONCABG (10.4%)] was comparable [RR 0.80(0.51-1.17); p=0.35; I2=30%]. Re-exploration for bleeding [RR 0.81(0.47-1.39); p=0.44] and blood transfusion [RR 0.79(0.57-1.08); p=0.14] were also comparable. While patients undergoing off-pump surgery were extubated earlier (p<0.01), other post-operative events like stroke (p=0.34) and atrial fibrillation (p=0.10) were similar. Mid-term survival (three to five years) was also comparable. Conclusion: Patients with end-stage renal disease undergoing coronary artery bypass grafting demonstrate comparable results irrespective of method. While available data is limited to retrospective studies, we failed to demonstrate any significant advantage for performing OPCABG in this group of patients.

Original languageEnglish (US)
Pages (from-to)55-61
Number of pages7
JournalHeart Lung and Circulation
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Off-Pump Coronary Artery Bypass
Chronic Kidney Failure
Meta-Analysis
Odds Ratio
Retrospective Studies
Coronary Artery Bypass
PubMed
Blood Transfusion
Atrial Fibrillation
Dialysis
Stroke
Confidence Intervals
Hemorrhage
Survival
Mortality

Keywords

  • Coronary artery bypass grafting
  • Dialysis
  • End-stage renal disease
  • Off-pump coronary artery bypass
  • Renal failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Does Off-pump Coronary Artery Bypass Confer any Advantage in Patients with End-stage Renal Failure? A Systematic Review and Meta-analysis. / Lim, Ju Yong; Deo, Salil V.; Jung, Sung Ho; Altarabsheh, Salah E.; Erwin, Patricia J.; Dillon, John J.; Park, Soon J.

In: Heart Lung and Circulation, Vol. 24, No. 1, 01.01.2015, p. 55-61.

Research output: Contribution to journalArticle

Lim, Ju Yong ; Deo, Salil V. ; Jung, Sung Ho ; Altarabsheh, Salah E. ; Erwin, Patricia J. ; Dillon, John J. ; Park, Soon J. / Does Off-pump Coronary Artery Bypass Confer any Advantage in Patients with End-stage Renal Failure? A Systematic Review and Meta-analysis. In: Heart Lung and Circulation. 2015 ; Vol. 24, No. 1. pp. 55-61.
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abstract = "Objectives: Patients with end-stage renal disease (ESRD) are often excluded from trials comparing off and on-pump coronary artery bypass grafting (CABG). Thus data in this cohort is limited to small retrospective studies. Hence we compared the adverse clinical events and outcome in patients with ESRD undergoing off (OPCABG) and on-pump surgery (ONCABG). Methods: Pubmed, Scopus and Web of Science were searched (inception - June 2013) to identify studies comparing clinical results of OPCABG and ONCABG in dialysis dependent patients. A random effect inverse variance weighted meta-analysis was conducted. Results are presented as risk ratios (RR) with 95{\%} confidence intervals; p. <. 0.05 is significant. Result: Ten retrospective studies (2762 OPCABG and 11310 ONCABG) fulfilled criteria and were pooled. Patients undergoing off-pump surgery were less than 100 in most of the articles. Early mortality [OPCABG (8.4{\%}); ONCABG (10.4{\%})] was comparable [RR 0.80(0.51-1.17); p=0.35; I2=30{\%}]. Re-exploration for bleeding [RR 0.81(0.47-1.39); p=0.44] and blood transfusion [RR 0.79(0.57-1.08); p=0.14] were also comparable. While patients undergoing off-pump surgery were extubated earlier (p<0.01), other post-operative events like stroke (p=0.34) and atrial fibrillation (p=0.10) were similar. Mid-term survival (three to five years) was also comparable. Conclusion: Patients with end-stage renal disease undergoing coronary artery bypass grafting demonstrate comparable results irrespective of method. While available data is limited to retrospective studies, we failed to demonstrate any significant advantage for performing OPCABG in this group of patients.",
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AU - Deo, Salil V.

AU - Jung, Sung Ho

AU - Altarabsheh, Salah E.

AU - Erwin, Patricia J.

AU - Dillon, John J.

AU - Park, Soon J.

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N2 - Objectives: Patients with end-stage renal disease (ESRD) are often excluded from trials comparing off and on-pump coronary artery bypass grafting (CABG). Thus data in this cohort is limited to small retrospective studies. Hence we compared the adverse clinical events and outcome in patients with ESRD undergoing off (OPCABG) and on-pump surgery (ONCABG). Methods: Pubmed, Scopus and Web of Science were searched (inception - June 2013) to identify studies comparing clinical results of OPCABG and ONCABG in dialysis dependent patients. A random effect inverse variance weighted meta-analysis was conducted. Results are presented as risk ratios (RR) with 95% confidence intervals; p. <. 0.05 is significant. Result: Ten retrospective studies (2762 OPCABG and 11310 ONCABG) fulfilled criteria and were pooled. Patients undergoing off-pump surgery were less than 100 in most of the articles. Early mortality [OPCABG (8.4%); ONCABG (10.4%)] was comparable [RR 0.80(0.51-1.17); p=0.35; I2=30%]. Re-exploration for bleeding [RR 0.81(0.47-1.39); p=0.44] and blood transfusion [RR 0.79(0.57-1.08); p=0.14] were also comparable. While patients undergoing off-pump surgery were extubated earlier (p<0.01), other post-operative events like stroke (p=0.34) and atrial fibrillation (p=0.10) were similar. Mid-term survival (three to five years) was also comparable. Conclusion: Patients with end-stage renal disease undergoing coronary artery bypass grafting demonstrate comparable results irrespective of method. While available data is limited to retrospective studies, we failed to demonstrate any significant advantage for performing OPCABG in this group of patients.

AB - Objectives: Patients with end-stage renal disease (ESRD) are often excluded from trials comparing off and on-pump coronary artery bypass grafting (CABG). Thus data in this cohort is limited to small retrospective studies. Hence we compared the adverse clinical events and outcome in patients with ESRD undergoing off (OPCABG) and on-pump surgery (ONCABG). Methods: Pubmed, Scopus and Web of Science were searched (inception - June 2013) to identify studies comparing clinical results of OPCABG and ONCABG in dialysis dependent patients. A random effect inverse variance weighted meta-analysis was conducted. Results are presented as risk ratios (RR) with 95% confidence intervals; p. <. 0.05 is significant. Result: Ten retrospective studies (2762 OPCABG and 11310 ONCABG) fulfilled criteria and were pooled. Patients undergoing off-pump surgery were less than 100 in most of the articles. Early mortality [OPCABG (8.4%); ONCABG (10.4%)] was comparable [RR 0.80(0.51-1.17); p=0.35; I2=30%]. Re-exploration for bleeding [RR 0.81(0.47-1.39); p=0.44] and blood transfusion [RR 0.79(0.57-1.08); p=0.14] were also comparable. While patients undergoing off-pump surgery were extubated earlier (p<0.01), other post-operative events like stroke (p=0.34) and atrial fibrillation (p=0.10) were similar. Mid-term survival (three to five years) was also comparable. Conclusion: Patients with end-stage renal disease undergoing coronary artery bypass grafting demonstrate comparable results irrespective of method. While available data is limited to retrospective studies, we failed to demonstrate any significant advantage for performing OPCABG in this group of patients.

KW - Coronary artery bypass grafting

KW - Dialysis

KW - End-stage renal disease

KW - Off-pump coronary artery bypass

KW - Renal failure

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