TY - JOUR
T1 - Off-pump coronary artery bypass reduces early stroke in octogenarians
T2 - A meta-analysis of 18,000 patients
AU - Altarabsheh, Salah E.
AU - Deo, Salil V.
AU - Rababa'H, Abeer M.
AU - Lim, Ju Yong
AU - Cho, Yang Hyun
AU - Sharma, Vikas
AU - Jung, Sung Ho
AU - Shin, Euisoo
AU - Markowitz, Alan H.
AU - Park, Soon J.
N1 - Publisher Copyright:
© 2015 The Society of Thoracic Surgeons.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.athoracsur.2014.12.057
DO - 10.1016/j.athoracsur.2014.12.057
M3 - Article
C2 - 25791924
AN - SCOPUS:84929502762
SN - 0003-4975
VL - 99
SP - 1568
EP - 1575
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -