Current evidence of coronary artery bypass grafting off-pump versus on-pump: A systematic review with meta-analysis of over 16 900 patients investigated in randomized controlled trials

European Journal of Cardio-thoracic Surgery

Volumn 49, Issue 4, 2016, Pages 1031-1041

  Deppe, Antje Christin ^a   Arbash, Wasim ^a   Kuhn, Elmar W ^a   Slottosch, Ingo ^a   Scherner, Maximilian ^a   Liakopoulos, Oliver J ^a   Choi, Yeong Hoon ^a   Wahlers, Thorsten ^a  

^a UNIVERSITY OF COLOGNE   (Germany)

Author keywords

CABG; Meta analysis; Off pump myocardial revascularization; On pump myocardial revascularization; OPCAB

Indexed keywords

CARDIOVASCULAR MORTALITY; CEREBROVASCULAR ACCIDENT; CORONARY ARTERY BYPASS GRAFT; FOLLOW UP; FORWARD HEART FAILURE; GRAFT FAILURE; HEART INFARCTION; HUMAN; INCIDENCE; INTERMETHOD COMPARISON; LENGTH OF STAY; MEDIASTINITIS; META ANALYSIS; OFF PUMP CORONARY SURGERY; ON PUMP CORONARY SURGERY; PRIORITY JOURNAL; QUALITY OF LIFE ASSESSMENT; RANDOMIZED CONTROLLED TRIAL (TOPIC); REOPERATION; REPEAT PROCEDURE; REVIEW; SYSTEMATIC REVIEW; ADVERSE EFFECTS; FEMALE; MALE; PROCEDURES; STATISTICS AND NUMERICAL DATA; TREATMENT OUTCOME;

CORONARY ARTERY BYPASS; FEMALE; HUMANS; LENGTH OF STAY; MALE; RANDOMIZED CONTROLLED TRIALS AS TOPIC; TREATMENT OUTCOME;

EID: 84963747218     PISSN: 10107940     EISSN: 1873734X     Source Type: Journal    
DOI: 10.1093/ejcts/ezv268     Document Type: Review

References (71)

1. Authors/Task Force m, Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2014;46:517-92.
2. Trapp WG, Bisarya R. Placement of coronary artery bypass graft without pump oxygenator. Ann Thorac Surg 1975;19:1-9.
3. Ankeny JL. Editorial: to use or not to use the pump oxygenator in coronary bypass operations. Ann Thorac Surg 1975;19:108-9.
4. Puskas J, Cheng D, Knight J, Angelini G, Decannier D, Diegeler A et al. Off-pump versus Conventional Coronary Artery Bypass Grafting: A Meta-Analysis and Consensus Statement from the 2004 ISMICS Consensus Conference. Innovations (Philadelphia, Pa) 2005;1:3-27.
5. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012;366:1489-97.
6. Lemma MG, Coscioni E, Tritto FP, Centofanti P, Fondacone C, Salica A et al. On-pump versus off-pump coronary artery bypass surgery in highrisk patients: operative results of a prospective randomized trial (on-off study). J Thorac Cardiovasc Surg 2012;143:625-31.
7. Diegeler A, Börgermann J, Kappert U, Breuer M, Böning A, Ursulescu A et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med 2013;368:1189-98.
8. Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Pallesen PA et al. OPCAB surgery is cost-effective for elderly patients. Scand Cardiovasc J 2013;47:185-92.
9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:e1-34.
10. Deppe AC, Liakopoulos OJ, Kuhn EW, Slottosch I, Scherner M, Choi YH et al. Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2885 patients. Eur J Cardiothorac Surg 2015;47:397-406.
11. Deppe AC, Liakopoulos OJ, Choi YH, Slottosch I, Kuhn EW, Scherner M et al. Endoscopic vein harvesting for coronary artery bypass grafting: a systematic review with meta-analysis of 27,789 patients. J Surg Res 2013;180: 114-24.
12. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.
13. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and nonrandomised studies of health care interventions. J Epidemiol Community Health 1998;52:377-84.
14. Paparella D, Galeone A, Venneri MT, Coviello M, Scrascia G, Marraudino N et al. Activation of the coagulation system during coronary artery bypass grafting: comparison between on-pump and off-pump techniques. J Thorac Cardiovasc Surg 2006;131:290-7.
15. Nesher N, Frolkis I, Vardi M, Sheinberg N, Bakir I, Caselman F et al. Higher levels of serum cytokines and myocardial tissue markers during on-pump versus off-pump coronary artery bypass surgery. J Card Surg 2006;21: 395-402.
16. Guler M, Kirali K, Toker ME, Bozbuga N, Omeroglu SN, Akinci E et al. Different CABG methods in patients with chronic obstructive pulmonary disease. Ann Thorac Surg 2001;71:152-7.
17. Bednar F, Osmancik P, Vanek T, Mocikova H, Jares M, Straka Z et al. Platelet activity and aspirin efficacy after off-pump compared with on-pump coronary artery bypass surgery: results from the prospective randomized trial PRAGUE 11-Coronary Artery Bypass and REactivity of Thrombocytes (CABARET). J Thorac Cardiovasc Surg 2008;136:1054-60.
18. Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T et al. Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. BMJ (Clin Res ed) 2006;332:1365.
19. Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 2002;359:1194-9.
20. Ascione R, Lloyd CT, Gomes WJ, Caputo M, Bryan AJ, Angelini GD. Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study. Eur J Cardiothorac Surg 1999;15: 685-90.
21. Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999;68:493-8.
22. Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 2000;69:1198-204.
23. Diegeler A, Hirsch R, Schneider F, Schilling LO, Falk V, Rauch T et al. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. Ann Thorac Surg 2000;69: 1162-6.
24. Fattouch K, Guccione F, Dioguardi P, Sampognaro R, Corrado E, Caruso M et al. Off-pump versus on-pump myocardial revascularization in patients with ST-segment elevation myocardial infarction: a randomized trial. J Thorac Cardiovasc Surg 2009;137:650-6; discussion 56-7.
25. Forouzannia SK, Abdollahi MH, Mirhosseini SJ, Hosseini H, Moshtaghion SH, Golzar A et al. Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery. Acta Med Iran 2011;49:414-9.
26. Gerola LR, Buffolo E, Jasbik W, Botelho B, Bosco J, Brasil LA et al. Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial. Ann Thorac Surg 2004;77:569-73.
27. Hernandez F Jr., Brown JR, Likosky DS, Clough RA, Hess AL, Roth RM et al. Neurocognitive outcomes of off-pump versus on-pump coronary artery bypass: a prospective randomized controlled trial. Ann Thorac Surg 2007; 84:1897-903.
28. Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH et al. On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. Circulation 2012;125:2431-9.
29. Hueb W, Lopes NH, Pereira AC, Hueb AC, Soares PR, Favarato D et al. Five-year follow-up of a randomized comparison between off-pump and on-pump stable multivessel coronary artery bypass grafting. The MASS III Trial. Circulation 2010;122:S48-52.
30. Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S et al. A randomized comparison of off-pump and on-pump multivessel coronaryartery bypass surgery. N Engl J Med 2004;350:21-8.
31. Kobayashi J, Tashiro T, Ochi M, Yaku H, Watanabe G, Satoh T et al. Early outcome of a randomized comparison of off-pump and on-pump multiple arterial coronary revascularization. Circulation 2005;112:I338-43.
32. Lee JD, Lee SJ, Tsushima WT, Yamauchi H, Lau WT, Popper J et al. Benefits of off-pump bypass on neurologic and clinical morbidity: a prospective randomized trial. Ann Thorac Surg 2003;76:18-25; discussion 25-6.
33. Legare JF, Buth KJ, King S, Wood J, Sullivan JA, Hancock Friesen C et al. Coronary bypass surgery performed off pump does not result in lower in-hospital morbidity than coronary artery bypass grafting performed on pump. Circulation 2004;109:887-92.
34. Lingaas PS, Hol PK, Lundblad R, Rein KA, Tonnesen TI, Svennevig JL et al. Clinical and Angiographic Outcome of Coronary Surgery with and without Cardiopulmonary Bypass: A Prospective Randomized Trial. Heart Surg Forum 2004;7:37-41.
35. Mandak J, Pojar M, Cibicek N, Lonsky V, Palicka V, Kakrdova D et al. Impact of cardiopulmonary bypass on peripheral tissue metabolism and microvascular blood flow. Perfusion 2008;23:339-46.
36. Mazzei V, Nasso G, Salamone G, Castorino F, Tommasini A, Anselmi A. Prospective randomized comparison of coronary bypass grafting with minimal extracorporeal circulation system (MECC) versus off-pump coronary surgery. Circulation 2007;116:1761-7.
37. Michaux I, Filipovic M, Skarvan K, Bolliger D, Schumann R, Bernet F et al. A randomized comparison of right ventricular function after on-pump versus off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2011;141:361-7.
38. Møller CH, Perko MJ, Lund JT, Andersen LW, Kelbaek H, Madsen JK et al. No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the best bypass surgery trial. Circulation 2010;121:498-504.
39. Motallebzadeh R, Bland JM, Markus HS, Kaski JC, Jahangiri M. Neurocognitive function and cerebral emboli: randomized study of on-pump versus offpump coronary artery bypass surgery. Ann Thorac Surg 2007;83:475-82.
40. Muneretto C, Bisleri G, Negri A, Manfredi J, Metra M, Nodari S et al. Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study. Ann Thorac Surg 2003;76:778-82; discussion 83.
41. Nathoe HM, van Dijk D, Jansen EWL, Suyker WJL, Diephuis JC, van Boven W-J et al. A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med 2003;348:394-402.
42. Niranjan G, Asimakopoulos G, Karagounis A, Cockerill G, Thompson M, Chandrasekaran V. Effects of cell saver autologous blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing cardiac surgery on- versus off-cardiopulmonary bypass: a randomised trial. Eur J Cardiothorac Surg 2006;30:271-7.
43. Onorati F, Rubino AS, Nucera S, Foti D, Sica V, Santini F et al. Off-pump coronary artery bypass surgery versus standard linear or pulsatile cardiopulmonary bypass: endothelial activation and inflammatory response. Eur J Cardiothorac Surg 2010;37:897-904.
44. Paulitsch FS, Schneider D, Sobel BE, Rached R, Ramires J, Jatene F et al. Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study. Coron Artery Dis 2009;20:100-5.
45. Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;125:797-808.
46. Raja SG, Haider Z, Ahmad M. Predictors of gastrointestinal complications after conventional and beating heart coronary surgery. Surgeon 2003;1: 221-8.
47. Sahlman A, Ahonen J, Nemlander A, Salmenpera M, Eriksson H, Ramo J et al. Myocardial metabolism on off-pump surgery; a randomized study of 50 cases. Scand Cardiovasc J 2003;37:211-5.
48. Sajja LR, Mannam G, Chakravarthi RM, Sompalli S, Naidu SK, Somaraju B et al. Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency: a randomized study. J Thorac Cardiovasc Surg 2007;133:378-88.
49. Sousa Uva M, Cavaco S, Oliveira AG, Matias F, Silva C, Mesquita A et al. Early graft patency after off-pump and on-pump coronary bypass surgery: a prospective randomized study. Eur Heart J 2010;31:2492-99.
50. Straka Z, Widimsky P, Jirasek K, Stros P, Votava J, Vanek T et al. Off-pump versus on-pump coronary surgery: final results from a prospective randomized study PRAGUE-4. Ann Thorac Surg 2004;77:789-93.
51. Tully PJ, Baker RA, Kneebone AC, Knight JL. Neuropsychologic and quality-of-life outcomes after coronary artery bypass surgery with and without cardiopulmonary bypass: a prospective randomized trial. J Cardiothorac Vasc Anesth 2008;22:515-21.
52. Vedin J, Antovic A, Ericsson A, Vaage J. Hemostasis in off-pump compared to on-pump coronary artery bypass grafting: a prospective, randomized study. Ann Thorac Surg 2005;80:586-93.
53. Vedin J, Jensen U, Ericsson A, Samuelsson S, Vaage J. Pulmonary hemodynamics and gas exchange in off pump coronary artery bypass grafting. Interact CardioVasc Thorac Surg 2005;4:493-7.
54. Vedin J, Nyman H, Ericsson A, Hylander S, Vaage J. Cognitive function after on or off pump coronary artery bypass grafting. Eur J Cardiothorac Surg 2006;30:305-10.
55. Wehlin L, Vedin J, Vaage J, Lundahl J. Activation of complement and leukocyte receptors during on- and off pump coronary artery bypass surgery. Eur J Cardiothorac Surg 2004;25:35-42.
56. Alwan K, Falcoz PE, Alwan J, Mouawad W, Oujaimi G, Chocron S et al. Beating versus arrested heart coronary revascularization: evaluation by cardiac troponin I release. Ann Thorac Surg 2004;77:2051-5.
57. Covino E, Santise G, Di Lello F, De Amicis V, Bonifazi R, Bellino I et al. Surgical myocardial revascularization (CABG) in patients with pulmonary disease: beating heart versus cardiopulmonary bypass. J Cardiovasc Surg 2001;42:23-6.
58. Kochamba GS, Yun KL, Pfeffer TA, Sintek CF, Khonsari S. Pulmonary abnormalities after coronary arterial bypass grafting operation: cardiopulmonary bypass versus mechanical stabilization. Ann Thorac Surg 2000;69:1466-70.
59. Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 2009;361:1827-37.
60. Carrier M, Perrault LP, Jeanmart H, Martineau R, Cartier R, Page P. Randomized trial comparing off-pump to on-pump coronary artery bypass grafting in high-risk patients. Heart Surg Forum 2003;6:E89-92.
61. Czerny M, Baumer H, Kilo J, Lassnigg A, Hamwi A, Vukovich T et al. Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. Eur J Cardiothorac Surg 2000;17:737-42.
62. Moller CH, Penninga L, Wetterslev J, Steinbruchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database Syst Rev 2012;3:Cd007224.
63. Harskamp RE, Bagai A, Halkos ME, Rao SV, Bachinsky WB, Patel MR et al. Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1,190 patients. Am Heart J 2014; 167:585-92.
64. Houlind K, Fenger-Gron M, Holme SJ, Kjeldsen BJ, Madsen SN, Rasmussen BS et al. Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: results from the Danish On-pump Versus Off-pump Randomization Study (DOORS). J Thorac Cardiovasc Surg 2014;148:1812-19.e2.
65. Giglio M, Dalfino L, Puntillo F, Rubino G, Marucci M, Brienza N. Haemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis. Interact CardioVasc Thorac Surg 2012;15:878-87.
66. Novitzky D, Baltz JH, Hattler B, Collins JF, Kozora E, Shroyer AL et al. Outcomes after conversion in the Veterans Affairs randomized on versus off bypass trial. Ann Thorac Surg 2011;92:2147-54.
67. Li Z, Amsterdam EA, Danielsen B, Hoegh H, Young JN, Armstrong EJ. Intraoperative conversion from off-pump to on-pump coronary artery bypass is associated with increased 30-day hospital readmission. Ann Thorac Surg 2014;98:16-22.
68. Horvath KA, Acker MA, Chang H, Bagiella E, Smith PK, Iribarne A et al. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg 2013;95:2194-201.
69. Rogers MA, Blumberg N, Heal JM, Hicks GL Jr. Increased risk of infection and mortality in women after cardiac surgery related to allogeneic blood transfusion. J Women's Health 2007;16:1412-20.
70. Angelini GD, Culliford L, Smith DK, Hamilton MC, Murphy GJ, Ascione R et al. Effects of on- and off-pump coronary artery surgery on graft patency, survival, and health-related quality of life: long-term follow-up of 2 randomized controlled trials. J Thorac Cardiovasc Surg 2009;137:295-303.
71. Puskas JD, Williams WH, O'Donnell R, Patterson RE, Sigman SR, Smith AS et al. Off-pump and on-pump coronary artery bypass grafting are associated with similar graft patency, myocardial ischemia, and freedom from reintervention: long-term follow-up of a randomized trial. Ann Thorac Surg 2011;91:1836-42; discussion 42-3.