Key result
Off-pump CABG reduces mortality ~25% versus on-pump CABG in patients with LV dysfunction.
Why the study?
Debate persists regarding the safety and efficacy of coronary artery bypass grafting with or without cardiopulmonary bypass, particularly in patients with left ventricular dysfunction.
Does off-pump CABG reduce mortality and perioperative morbidities compared to on-pump CABG in patients with multivessel coronary artery disease and left ventricular dysfunction?
Meta-Analysis (n=35,863)
Does off-pump CABG reduce mortality and perioperative morbidities compared to on-pump CABG in patients with multivessel coronary artery disease and left ventricular dysfunction?
Effect estimate: RR 0.75 (95% CI 0.60-0.93)
p-value: p=0.009
In patients with multivessel coronary artery disease and reduced left ventricular function, off-pump CABG is associated with significantly lower perioperative mortality and morbidity compared to on-pump CABG.
Supports off-pump CABG in left ventricular dysfunction; confirms lower mortality and morbidity versus on-pump in meta-analysis.
The ongoing debate surrounding coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass persists, particularly in individuals with left ventricular dysfunction. The objective of this study was to evaluate the safety and efficacy of these 2 strategies through a comprehensive meta-analysis of existing studies. A systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Central Registry was conducted from inception to July 2023. The primary focus was on studies comparing on-pump versus off-pump CABG as the primary treatment for multivessel coronary artery disease in patients with left ventricular dysfunction (ejection fraction ≤40%), with mortality as the primary outcome. The meta-analysis included 26 studies with a total of 35,863 patients. The results revealed a significant reduction in mortality risk [risk ratio (RR), 0.75; 95% confidence interval (CI), 0.60-0.93; P = 0.009] and other perioperative morbidities associated with off-pump CABG. These included stroke (RR, 0.67; 95% CI, 0.54-0.82; P = 0.0002), myocardial infarction (RR, 0.74; 95% CI, 0.56-0.97; P = 0.03), pulmonary complications (RR, 0.71; 95% CI, 0.55-0.92; P = 0.010), postoperative transfusion (RR, 0.70; 95% CI, 0.55-0.88; P = 0.002), neurological dysfunction (RR, 0.80; 95% CI, 0.64-1.00; P = 0.05), infection (RR, 0.74; 95% CI, 0.56-0.97; P = 0.03), renal failure (RR, 0.79; 95% CI, 0.67-0.95; P = 0.010), and reoperation for bleeding (RR, 0.66; 95% CI, 0.52-0.84; P = 0.0006). However, no significant difference was observed between the 2 groups regarding postoperative atrial fibrillation (RR, 0.97; 95% CI, 0.84-1.12; P = 0.69). In conclusion, off-pump CABG demonstrates a lower perioperative mortality risk and improved overall early outcomes compared with on-pump techniques in individuals with reduced left ventricular function.
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Qadeer et al. (2024) conducted a meta-analysis in Multivessel coronary artery disease with left ventricular dysfunction (n=35,863). Off-pump CABG vs. On-pump CABG was evaluated on Mortality (RR 0.75, 95% CI 0.60-0.93, p=0.009). Off-pump CABG significantly reduced mortality risk compared to on-pump CABG in patients with left ventricular dysfunction (RR 0.75; 95% CI 0.60-0.93; P=0.009).
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