Yushu Wang1, Sui Zhu2, Peijuan Gao3, Juteng Zhou1, Qing Zhang4. 1. Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China. 2. Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, Chengdu, Sichuan, China. 3. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 4. Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China. zhangqingdoc@126.com.
Abstract
BACKGROUND: Patients with chronic kidney disease (CKD) have worse adverse cardiovascular outcomes after coronary artery bypass grafting (CABG). However, the adverse cardiovascular outcomes between off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in these patients have been a subject of debate. METHODS: We undertook a comprehensive literature search of PubMed, Embase, and the Cochrane Library database to identify all relevant studies comparing techniques between OPCAB and ONCAB in CKD patients. We pooled the odds ratios (ORs) and hazard ratios (HRs) from individual studies and conducted heterogeneity, quality assessment, and publication bias analyses. RESULTS: This meta-analysis includes 17 studies with 201,889 patients. In CKD patients, OPCAB was associated with significantly lower early mortality as compared to ONCAB (OR 0.88; 95% CI 0.82-0.93; p < 0.0001). OPCAB was associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI 0.34-0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22-0.95; p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08-0.49; p = 0.0005), pneumonia, prolonged ventilation, and shorter hospital stays. No difference was found regarding long-term survival (HR 1.08; 95% CI 0.86-1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30-1.38; p = 0.26). CONCLUSIONS: Compared with ONCAB, OPCAB is associated with superior postoperative morbidity and the early mortality in CKD patients. Long-term survival is comparable between the two surgical revascularizations.
BACKGROUND:Patients with chronic kidney disease (CKD) have worse adverse cardiovascular outcomes after coronary artery bypass grafting (CABG). However, the adverse cardiovascular outcomes between off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in these patients have been a subject of debate. METHODS: We undertook a comprehensive literature search of PubMed, Embase, and the Cochrane Library database to identify all relevant studies comparing techniques between OPCAB and ONCAB in CKDpatients. We pooled the odds ratios (ORs) and hazard ratios (HRs) from individual studies and conducted heterogeneity, quality assessment, and publication bias analyses. RESULTS: This meta-analysis includes 17 studies with 201,889 patients. In CKDpatients, OPCAB was associated with significantly lower early mortality as compared to ONCAB (OR 0.88; 95% CI 0.82-0.93; p < 0.0001). OPCAB was associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI 0.34-0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22-0.95; p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08-0.49; p = 0.0005), pneumonia, prolonged ventilation, and shorter hospital stays. No difference was found regarding long-term survival (HR 1.08; 95% CI 0.86-1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30-1.38; p = 0.26). CONCLUSIONS: Compared with ONCAB, OPCAB is associated with superior postoperative morbidity and the early mortality in CKDpatients. Long-term survival is comparable between the two surgical revascularizations.
Authors: L David Hillis; Peter K Smith; Jeffrey L Anderson; John A Bittl; Charles R Bridges; John G Byrne; Joaquin E Cigarroa; Verdi J Disesa; Loren F Hiratzka; Adolph M Hutter; Michael E Jessen; Ellen C Keeley; Stephen J Lahey; Richard A Lange; Martin J London; Michael J Mack; Manesh R Patel; John D Puskas; Joseph F Sabik; Ola Selnes; David M Shahian; Jeffrey C Trost; Michael D Winniford Journal: Circulation Date: 2011-11-07 Impact factor: 29.690
Authors: William Chan; Joan Ivanov; Dennis Ko; Stephen Fremes; Vivek Rao; Sanjit Jolly; Warren J Cantor; Shahar Lavi; Christopher B Overgaard; Marc Ruel; Jack V Tu; Vladimír Džavík Journal: Circ Cardiovasc Interv Date: 2015-01 Impact factor: 6.546
Authors: Bryon J Boulton; Patrick Kilgo; Robert A Guyton; John D Puskas; Omar M Lattouf; Edward P Chen; Willam A Cooper; J David Vega; Michael E Halkos; Vinod H Thourani Journal: Ann Thorac Surg Date: 2011-06-25 Impact factor: 4.330
Authors: Todd M Dewey; Morley A Herbert; Syma L Prince; Carrie L Robbins; Christina M Worley; Mitchell J Magee; Michael J Mack Journal: Ann Thorac Surg Date: 2006-02 Impact factor: 4.330
Authors: Edward L Hannan; Chuntao Wu; Craig R Smith; Robert S D Higgins; Russell E Carlson; Alfred T Culliford; Jeffrey P Gold; Robert H Jones Journal: Circulation Date: 2007-08-20 Impact factor: 29.690
Authors: Li Zhang; Steven W Boyce; Peter C Hill; Xiumei Sun; Ann Lee; Elizabeth Haile; Jorge M Garcia; Paul J Corso Journal: Cardiovasc Revasc Med Date: 2009 Jan-Mar
Authors: Mario Gaudino; Gianni D Angelini; Charalambos Antoniades; Faisal Bakaeen; Umberto Benedetto; Antonio M Calafiore; Antonino Di Franco; Michele Di Mauro; Stephen E Fremes; Leonard N Girardi; David Glineur; Juan Grau; Guo-Wei He; Carlo Patrono; John D Puskas; Marc Ruel; Thomas A Schwann; Derrick Y Tam; James Tatoulis; Robert Tranbaugh; Michael Vallely; Marco A Zenati; Michael Mack; David P Taggart Journal: J Am Heart Assoc Date: 2018-08-21 Impact factor: 5.501