Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies

Journal of Cardiothoracic Surgery

Thanos Athanasiou¹  Roberto Casula¹  Hutan Ashrafian¹  Leanne Harling¹  Amir H Sepehripour¹ 

[1] Department of Surgery and Cancer, 10th Floor QEQM Building, St Mary’s Hospital, Imperial College London, London W2 1NY, UK

关键词: Organ protection;    Morbidity;    Off-pump;    Coronary artery bypass grafting;    Re-operative;   

Others  :  803363
DOI  :  10.1186/1749-8090-9-115

 received in 2014-04-07, accepted in 2014-06-16,  发布年份 2014

【 摘 要 】

Off-pump coronary artery bypass surgery (OPCAB) has been hypothesised to be beneficial in the high-risk patient population undergoing re-operative coronary artery bypass graft surgery (CABG). In addition, this technique has been demonstrated to provide subtle benefits in end-organ function including heart, lungs and kidney. The aims of this study were to assess whether OPCAB is associated with a lower incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and other adverse outcomes in re-operative coronary surgery. Twelve studies, incorporating 3471 patients were identified by systematic literature review. These were meta-analysed using random-effects modelling. Primary endpoints were MACCE and other adverse outcomes including myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation. A significantly lower incidence of myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation was observed with OPCAB (OR 0.58; 95% CI (confidence interval) [0.39-0.87]; OR 0.37; 95% CI [0.17-0.79]; OR 0.39; 95% CI [0.24-0.63]; OR 0.14; 95% CI [0.04-0.56]; OR 0.36; 95% CI [0.24-0.54]; OR 0.41; 95% CI [0.22-0.77] respectively). Sub-group analysis using sample size, matching score and quality score was consistent with and reflected these significant findings. Off-pump coronary artery bypass grafting reduces peri-operative and short-term major adverse outcomes in patients undergoing re-operative surgery. Consequently we conclude that OPCAB provides superior organ protection and a safer outcome profile in re-operative CABG.

【 授权许可】

   
2014 Sepehripour et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

【 参考文献 】

• [1]Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, Straka Z, Piegas LS, Akar AR, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Vaijyanath P, Reddy S, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Ng J, Chrolavicius S, Yusuf S, CORONARY Investigators: Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012, 366:1489-1497.
• [2]Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, Straka Z, Piegas LS, Akar AR, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Vaijyanath P, Reddy S, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Ng J, Chrolavicius S, Yusuf S, CORONARY Investigators: Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med 2013, 368:1179-1188.
• [3]Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, Lucke JC, Baltz JH, Novizky D, Affairs Randomized On/Off Bypass (ROOBY) Study Group: Veterans’ On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 2009, 361:1827-1837.
• [4]Emmert MY, Salzberg SP, Seifert B, Rodriguez H, Plass A, Hoerstrup SP, Grunenfelder J, Falk V: Is off-pump superior to conventional coronary artery bypass grafting in diabetic patients with multivessel disease? Eur J Cardiothorac Surg 2011, 40:233-239.
• [5]Puskas JD, Kilgo PD, Lattouf OM, Thourani VH, Cooper WA, Vassiliades TA, Chen EP, Vega JD, Guyton RA: Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. Ann Thorac Surg 2008, 86:1139-1146. discussion 1146
• [6]Sepehripour AH, Saso S, Harling L, Punjabi P, Ashrafian H, Athanasiou T: Does off-pump coronary revascularisation reduce mortality in re-operative coronary artery surgery? A meta-analysis of observational studies. Perfusion 2013, 28:340-349.
• [7]Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009, 339:b2535.
• [8]Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB: Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000, 283:2008-2012.
• [9]Taggart DP, D’Amico R, Altman DG: Effect of arterial revascularization on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001, 358:870-875.
• [10]Alamanni F, Pompilio G, Polvani G, Agrifoglio M, Zanobini M, Parolari A, Cannata A, Biglioli P: Off-pump redo coronary artery bypass grafting: technical aspects and early results. Heart Surg Forum 2002, 5(Suppl 4):S432-444.
• [11]Bergsland J, Hasnain S, Lajos TZ, Salerno TA: Elimination of cardiopulmonary bypass: a prime goal in reoperative coronary artery bypass surgery. Eur J Cardiothorac Surg 1998, 14:59-62. discussion 62–63
• [12]Czerny M, Zimpfer D, Kilo J, Gottardi R, Dunkler D, Wolner E, Grimm M: Coronary reoperations: recurrence of angina and clinical outcome with and without cardiopulmonary bypass. Ann Thorac Surg 2003, 75:847-852.
• [13]D’Ancona G, Karamanoukian H, Ricci M, Salerno T, Lajos T, Bergsland J: Reoperative coronary artery bypass grafting with and without cardiopulmonary bypass: determinants of perioperative morbidity and mortality. Heart Surg Forum 2001, 4:152-158. dicussion 158–159
• [14]Dewey TM, Magee MJ, Acuff T, Prince S, Herbert M, Edgerton JR, Mack MJ: Beating heart surgery reduces mortality in the reoperative bypass patient. Heart Surg Forum 2002, 5(Suppl 4):S301-316.
• [15]Gerli C, Mantovani L, Franco A, De Luca M, Bergonzi PC, Boroli F, Romano A, Landoni G, Zangrillo A: Redo coronary artery bypass grafting on the beating heart and transfusion needs. Minerva Anestesiol 2006, 72:985-993.
• [16]Mishra YK, Collison SP, Malhotra R, Kohli V, Mehta Y, Trehan N: Ten-year experience with single-vessel and multivessel reoperative off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2008, 135:527-532.
• [17]Morris CD, Puskas JD, Pusca SV, Lattouf OM, Cooper WA, Vassiliades TA, Chen EP, Thourani VH, Kilgo PD, Guyton RA: Outcomes after off-pump reoperative coronary artery bypass grafting. Innovations (Phila) 2007, 2:29-32.
• [18]Schutz A, Mair H, Wildhirt SM, Gillrath G, Lamm P, Kilger E, Reichart B: Re-OPCAB vs. Re-CABG for myocardial revascularization. Thorac Cardiovasc Surg 2001, 49:144-148.
• [19]Teodori G, Iaco AL, Di Mauro M, Cini R, Di Giammarco G, Vitolla G, Calafiore AM: Reoperative coronary surgery with and without cardiopulmonary bypass. J Card Surg 2000, 15:303-308.
• [20]Tugtekin SM, Alexiou K, Kappert U, Esche E, Joskowiak D, Knaut M, Matschke K: Coronary reoperation with and without cardiopulmonary bypass. Clin Res Cardiol 2006, 95:93-98.
• [21]Vohra HA, Bahrami T, Farid S, Mafi A, Dreyfus G, Amrani M, Gaer JA: Propensity score analysis of early and late outcome after redo off-pump and on-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 2008, 33:209-214.
• [22]Ghanta RK, Kaneko T, Gammie JS, Sheng S, Aranki SF: Evolving trends of reoperative coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg 2013, 145:364-372.