| Title | Short-term outcomes of on- vs off-pump coronary artery bypass grafting in patients with left ventricular dysfunction: a systematic review and meta-analysis |
| Authors | Guan, Zhiyuan Guan, Xiaoqing Gu, Kaiyun Lin, Xuanqi Lin, Jin Zhou, Wenjun Xu, Ming Wan, Fen Zhang, Zhe Song, Chunli |
| Affiliation | Peking Univ, Hosp 3, Dept Cardiol Surg, 49 North Garden Rd, Beijing 100191, Peoples R China Peking Univ, Beijing 100871, Peoples R China Beijing Univ Technol, Beijing 100124, Peoples R China Peking Univ, Dept Cardiol, NHC Key Lab Cardiovasc Mol Biol & Regulatory Pept, Hosp 3, Beijing 100191, Peoples R China Tongji Univ, Shanghai East Hosp, 150 Jimo Rd, Shanghai 100124, Peoples R China Peking Univ, Dept Orthoped, Hosp 3, 49 North Garden Rd, Beijing 100191, Peoples R China |
| Keywords | LOW EJECTION FRACTION ON-PUMP CARDIOPULMONARY BYPASS INDEPENDENT PREDICTOR OPERATIVE MORTALITY REVASCULARIZATION SURGERY RISK MORBIDITY STROKE |
| Issue Date | 11-May-2020 |
| Publisher | JOURNAL OF CARDIOTHORACIC SURGERY |
| Abstract | ObjectivesDoes the manipulation of the off-pump CABG (OPCAB) in patient with depressed left ventricular function is better than on-pump CABG (ONCAB) approach in in-hospital mortality and morbidities? Here we undertook a meta-analysis of the best evidence available on the comparison of primary and second clinical outcomes of the off-pump and on-pump CABG.DesignSystematic literature reviewer and meta-analysis.Data sourcesPubMed, EMBASE, Web of science and Cochrane Center Registry of Controlled Trials were searched the studies which comparing the use of the off-pump CABG(OPCAB) and on-pump CABG (ONCAB) for patients with LVD during January 1990.1 to January 2018.Eligibility criteriaAll observation studies and randomized controlled trials comparing on-pump and off-pump as main technique for multi-vessel coronary artery disease (defined as severe stenosis (>70%) in at least 2 major diseased coronary arteries) with left ventricular dysfunction(defined as ejection fraction (EF) 40% or less) were included.Data extraction and synthesisAuthors will screen and select the studies extract the following data, first author, year of publication, trial characters, study design, inclusion and exclusion criteria, graft type, clinical outcome, assess the risk of bias and heterogeneity. Study-specific estimates will pool through the modification of the Newcastle-Ottawa scale for the quality of study and while leave-one-out analysis will be used to detect the impact of individual studies on the robustness of outcomes.ResultsAmong the 987 screened articles, a total of 16 studies (32,354 patients) were included. A significant relationship between patient risk profile and benefits from OPCAB was found in terms of the 30-day mortality (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73-0.97; P=0.02), stroke (OR, 0.69; 95% CI, 0.55-0.86; P=0.00), myocardial infarction (MI) (OR, 0.71; 95% CI, 0.53-0.96; P=0.02), renal failure (OR, 0.71; 95% CI, 0.55-0.93; P=0.01), pulmonary complication (OR, 0.68; 95% CI, 0.52-0.90; P=0.01), infection (OR, 0.67; 95% CI, 0.49-0.91; P=0.00),postoperative transfusion (OR, 0.25; 95% CI, 0.08-0.84; P=0.02) and reoperation for bleeding (OR, 0.56; 95% CI, 0.41-0.75; P=0.00). There was no significant difference in atrial fibrillation (AF) (OR, 0.96;95%; CI, 0.78-1.41; P=0.56) and neurological dysfunction (OR, 0.88; 95% CI, 0.49-1.57; P=0.65).ConclusionsCompared with the on-pump CABG with LVD, using the off-pump CABG is a better choice for patients with lower mortality, stroke, MI, RF, pulmonary complication, infection, postoperative transfusion and reoperation for bleeding. Further randomized studies are warranted to corroborate these observational data. |
| URI | http://hdl.handle.net/20.500.11897/589090 |
| DOI | 10.1186/s13019-020-01115-0 |
| Indexed | SCI(E) Scopus |
| Appears in Collections: | 第三医院 |
