On-pump Versus Off-pump CABG: What Is the Current Wisdom?
At a 2015 International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) conference, an international group of prominent cardiothoracic surgeons presented evidence-informed consensus statements on the risks and benefits of off-pump coronary artery bypass grafting (OPCAB) surgery with regards to mortality, morbidity and resource use versus conventional on-pump coronary artery bypass (CCAB) surgery.
To arrive at their recommendations, the group systematically screened all randomized controlled trials (RCTs ) of OPCAB versus CCAB surgery through April 2013 and reviewed the results of 102 relevant RCTs (19,101 patients). A meta-analysis (15 RCTs of 9,551 high-risk patients, and 87 RCTs of 9,550 low-risk patients) was also performed in accordance with the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology.
They found that performing OPCAB reduces the risks of stroke, renal dysfunction/failure, blood transfusion, respiratory failure, atrial fibrillation, wound infection, ventilation time and ICU and hospital lengths of stay.
However, they also discovered that OPCAB, in comparison to CCAB, may be associated with a reduced number of grafts performed, diminished graft patency, increased coronary reintervention at one year and beyond, and increased mortality at a median follow-up of five years.
They concluded that OPCAB, compared with CCAB, may improve short-term outcomes, but, over the longer-term, OPCAB may be associated with reduced graft patency and increased risk of cardiac re-intervention and death.
Ref: Puskas JD, Martin J, Cheng DC, Benussi S, Bonatti JO, Diegeler A, Ferdinand FD, Kieser TM, Lamy A, Mack MJ, Patel NC, Ruel M, Sabik JF 3rd, Yanagawa B, Zamvar V, “ISMICS Consensus Conference and Statements of Randomized Controlled Trials of Off-Pump Versus Conventional Coronary Artery Bypass Surgery,” Innovations (Phila) 2015; 10(4): 219-29.