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Background <p>The efficacy and safety of off-pump relative to on-pump coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) remain unclear.</p> Objectives <p>Conduct a meta-analysis assessing the outcomes following CABG comparing off-pump CABG vs. on-pump CABG.</p> Methods <p>MEDLINE, Cochrane, and Embase were examined for randomized controlled trials (RCTs) and observational studies that communicated outcomes after off-pump vs. on-pump CABG in patients with LMCAD. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Cochrane recommendations for quality assessment and risk of bias were performed. This study was registered in the PROSPERO platform, ID: CRD42023451467.</p> Results <p>One RCT and 17 observational studies with 16,848 patients were included, 6735 (40.0%) of whom underwent off-pump CABG. In patients with LMCAD undergoing CABG, off-pump CABG was associated with a lower incidence of all-cause mortality (OR 0.52, 95% CI 0.38–0.71; <i>p</i> &lt; 0.001), acute renal dysfunction (OR 0.40; 95% CI 0.27–0.59; <i>p</i> &lt; 0.001), postoperative use of intra-aortic balloon pump (IABP) (OR 0.38; 95% CI 0.22–0.64; <i>p</i> &lt; 0.01), and wound infection (OR 0.66; 95% CI 0.48–0.9; <i>p</i> = 0.01). There was no difference between the groups for myocardial infarction (OR 0.81; 95% CI 0.59–1.11; <i>p</i> = 0.193), stroke, or transitional ischemic attack (TIA) (OR 0.64; 95% CI 0.38–1.06; <i>p</i> = 0.085). The number of grafts per patient was also lower in the off-pump CABG group (mean deviation (MD) –0.32; 95% CI –0.50 to –0.14; <i>p</i> &lt; 0.001). After a mean follow-up of 38.1&#xa0;months, no significant difference in all-cause mortality incidence was observed between the two techniques (OR 0.72; 95% CI 0.30–1.74; <i>p</i> = 0.47). This underscores that the reduction in mortality rates was primarily driven by short-term outcomes.</p> Conclusion <p>In this meta-analysis with 16,848 patients with LMCAD undergoing CABG, off-pump CABG was associated with lower rates of all-cause mortality, acute renal dysfunction, IABP use, and wound infection compared with on-pump CABG.</p> Graphical Abstract <p>On-pump versus off-pump CABG in patients with LMCAD</p>

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Short-term outcomes of off-pump vs. on-pump coronary artery bypass grafting in left main coronary artery disease: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年3月6日

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  • Lucas Nogueira Pansani,
  • Pedro Emanuel de Paula Carvalho,
  • Douglas Gewehr,
  • Maurizio Taramasso,
  • Giullia Burkhardt,
  • Lara Almeidinha,
  • Rafael Ayala,
  • Martin Tobias Robert Grapow

摘要

Background

The efficacy and safety of off-pump relative to on-pump coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) remain unclear.

Objectives

Conduct a meta-analysis assessing the outcomes following CABG comparing off-pump CABG vs. on-pump CABG.

Methods

MEDLINE, Cochrane, and Embase were examined for randomized controlled trials (RCTs) and observational studies that communicated outcomes after off-pump vs. on-pump CABG in patients with LMCAD. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Cochrane recommendations for quality assessment and risk of bias were performed. This study was registered in the PROSPERO platform, ID: CRD42023451467.

Results

One RCT and 17 observational studies with 16,848 patients were included, 6735 (40.0%) of whom underwent off-pump CABG. In patients with LMCAD undergoing CABG, off-pump CABG was associated with a lower incidence of all-cause mortality (OR 0.52, 95% CI 0.38–0.71; p < 0.001), acute renal dysfunction (OR 0.40; 95% CI 0.27–0.59; p < 0.001), postoperative use of intra-aortic balloon pump (IABP) (OR 0.38; 95% CI 0.22–0.64; p < 0.01), and wound infection (OR 0.66; 95% CI 0.48–0.9; p = 0.01). There was no difference between the groups for myocardial infarction (OR 0.81; 95% CI 0.59–1.11; p = 0.193), stroke, or transitional ischemic attack (TIA) (OR 0.64; 95% CI 0.38–1.06; p = 0.085). The number of grafts per patient was also lower in the off-pump CABG group (mean deviation (MD) –0.32; 95% CI –0.50 to –0.14; p < 0.001). After a mean follow-up of 38.1 months, no significant difference in all-cause mortality incidence was observed between the two techniques (OR 0.72; 95% CI 0.30–1.74; p = 0.47). This underscores that the reduction in mortality rates was primarily driven by short-term outcomes.

Conclusion

In this meta-analysis with 16,848 patients with LMCAD undergoing CABG, off-pump CABG was associated with lower rates of all-cause mortality, acute renal dysfunction, IABP use, and wound infection compared with on-pump CABG.

Graphical Abstract

On-pump versus off-pump CABG in patients with LMCAD