Off-pump coronary artery bypass reduces early stroke in octogenarians: A meta-analysis of 18,000 patients

Salah E. Altarabsheh, Salil V. Deo, Abeer M. Rababa'H, Ju Yong Lim, Yang Hyun Cho, Vikas Sharma, Sung Ho Jung, Euisoo Shin, Alan H. Markowitz, Soon J. Park

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Background Data comparing results of off-pump and conventional operations in octogenarians is very limited. Thus we chose to compare early adverse events between off-pump coronary artery bypass grafting (OPCABG) and on-pump CABG (ONCABG) in patients older than 80 years. Methods Systematic review of multiple databases was performed to obtain original studies fulfilling search criteria. End points - early mortality, stroke, respiratory failure, atrial fibrillation, and myocardial infarction - were compared between these cohorts. A random-effects weighted analysis was performed using the trim-fill adjustment when necessary. Results are presented as risk ratios (RRs) with 95% confidence intervals (CIs); p < 0.05 is considered statistically significant. Results Sixteen retrospective studies (9,744 ONCABG and 8,566 OPCABG patients) were included in the systematic review. OPCAGB patients received significantly fewer grafts (2.54 ± 0.16) compared with ONCABG patients (3.22 ± 0.41). Early mortality was comparable at 4.6% and 5.2% in the OPCABG and ONCABG cohorts, respectively (risk ratio [RR], 0.91; 95% CI, 0.64-1.28; p = 0.598). Stroke rates were higher in the ONCABG cohort (RR, 0.65; 95% CI, 0.49- 0.87; p < 0.01). Respiratory failure was higher with ONCABG (RR, 0.74; 95% CI, 0.57-0.97; p = 0.03). New-onset renal failure (p = 0.99), atrial fibrillation (p = 0.27), and myocardial infarction (p = 0.99) were comparable. Conclusions Coronary artery bypass in octogenarians can be performed safely with low early mortality. Although off-pump operations reduce the risk of early stroke, all other adverse events are comparable in on- and off-pump coronary artery bypass operations. Data regarding late mortality is at present limited; however, both on- and off-pump procedures appear to produce comparable survival.

Original languageEnglish (US)
Pages (from-to)1568-1575
Number of pages8
JournalAnnals of Thoracic Surgery
Volume99
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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