On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis

A hybrid procedure of beating-heart coronary artery bypass grafting (CABG) with the concomitant use of cardiopulmonary bypass termed on-pump beating-heart CABG (ON-BH CABG) has emerged as an alternative for high-risk patient populations. Although several studies have reported the advantage of ON-BH CABG in high-risk patients, the clinical benefit of ON-BH CABG is still under discussion. Here, we performed a meta-analysis of the data derived from published studies comparing the clinical outcomes of ON-BH CABG with that of conventional arrested heart CABG. Medline, Embase and Scopus databases were searched for relevant publications up to March 2015. A systematic review of the published literature identified 14 published studies incorporating 2040 patients (884 ON-BH CABG and 1156 conventional CABG). Odds ratios (ORs) for binary variables or weighted mean difference for continuous variables were combined using the inverse variance method in a fixed-effects model. Study heterogeneity was tested using Cochran's Q test and the publication bias was assessed using Begg's and Egger's tests. The fixed-effects meta-analysis for early mortality showed that ON-BH CABG provided a 45% lower risk of early mortality compared with conventional CABG (OR 0.553; 95% confidence interval [CI] 0.376-0.815; P = 0.003). There was minimal heterogeneity in the included studies (P = 0.29) and no evidence of significant publication bias. A sensitivity analysis, including a random-effects meta-analysis (OR 0.552; 95% CI 0.356-0.856; P = 0.008) and a one-study-removed meta-analysis, supported the validity of the primary analysis for early mortality. There was significantly lower perioperative morbidity associated with ON-BH CABG, including myocardial infarction (OR 0.294; 95% CI 0.141-0.613; P = 0.001), renal failure (OR 0.362; 95% CI 0.209-0.626; P < 0. 001) and low output syndrome (OR 0.330; 95% CI 0.197-0.551; P < 0.001) with no significant heterogeneity. In conclusion, current evidence from comparative studies indicates that ON-BH CABG is associated with significantly lower early morbidity and mortality. The ON-BH CABG could be an attractive planned alternative for high-risk patient populations.