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OFF-PUMP CABG SURGERY FOR REDUCTION OF PERIOPERATIVE MORTALITY AND MORBIDITY: A META-ANALYSIS

Department of Anesthesia and Division of Cardiac Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4

BACKGROUND: Despite its theoretical benefits, the effects of off-pump coronary bypass surgery (OPCAB) on perioperative mortality and morbidity remain unclear. This systematic review assessed the effects of OPCAB on short- and long-term outcomes.

METHODS: MEDLINE, EMBASE, and reference lists were searched without language restriction for relevant randomized controlled trials (RCT) and observational studies. Included observational studies had to employ appropriate risk-adjustment techniques, namely multiple logistic regression or propensity-score techniques. Pooled treatment effects were calculated as odds ratios (OR) with 95% confidence intervals (CI).

RESULTS: Twenty-three RCTs (N = 1861) and 16 observational studies (N = 294,413) were included. Among RCTs, OPCAB was associated with trends towards reduced 30-day mortality (OR 0.81 95%CI 0.26–2.55), stroke (OR 0.52; 95%CI 0.18–1.47), and myocardial infarction (OR 0.74; 95%CI 0.38–1.46); as well as significant reductions in atrial fibrillation (OR 0.48; 95%CI 0.31–0.74). Among observational studies, OPCAB was associated with significantly reduced 30-day mortality (OR 0.75; 95%CI 0.69–0.82), stroke (OR 0.62; 95%CI 0.55–0.69), and atrial fibrillation (OR0.77; 95%CI 0.72–0.83); as well as trends towards reduced infarction (OR 0.77; 95%CI 0.48–1.23). In the few studies reporting long-term (1–2 years) outcomes, OPCAB remained associated with trends towards reduced mortality and infarction, but also trends towards increased need for repeat revascularization (RCT data: OR 1.72; 95%CI 0.73–4.06).

CONCLUSIONS: RCTs and risk-adjusted observational studies demonstrate qualitatively similar improvements in short-term perioperative mortality and morbidity following OPCAB. Future research must address the paucity of long-term outcome data, especially given that OPCAB may be associated with an increased need for repeat revascularization.

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				W. S. Beattie Evidence-based perioperative risk reduction Can J Anesth, June 1, 2005; 52(suppl_1): R5 - R5. [Full Text] [PDF]

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