REVIEW  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2022 February;63(1):60-8

DOI: 10.23736/S0021-9509.21.12012-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

A systematic review and meta-analysis of randomized controlled studies comparing off-pump versus on-pump coronary artery bypass grafting in the elderly

Rui J. MACHADO ¹, Francisca A. SARAIVA ¹, Jennifer MANCIO ^{1, 2}, Patrícia SOUSA, Rui J. CERQUEIRA ³, António S. BARROS ¹, André P. LOURENÇO ⁴, Adelino F. LEITE-MOREIRA ^{1, 3} ✉

¹ Department of Surgery and Physiology and Cardiovascular Research, Development Center, Faculty of Medicine, University of Porto, Porto, Portugal; ² Department of Intensive Care and Perioperative Medicine, Royal Brompton and Harefield & Guys and St. Thomas NHS Foundation Trust, London, UK; ³ Department of Cardiothoracic Surgery, São João University Hospital, Porto, Portugal; ⁴ Department of Anesthesiology, São João University Hospital, Porto, Portugal

INTRODUCTION: Comparison of short and mid-term outcomes between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) in patients older than 65 throughout a meta-analysis of randomized clinical trials (RCTs).
EVIDENCE ACQUISITION: A literature search was conducted using 3 databases. RCTs reporting mortality outcomes of OPCAB versus ONCAB among the elderly were included. Data on myocardial infarction, stroke, re-revascularization, renal failure and composite endpoints after CABG were also collected. Random effects models were used to compute statistical combined measures and 95% confidence intervals (CI).
EVIDENCE SYNTHESIS: Five RCTs encompassing 6221 patients were included (3105 OPCAB and 3116 ONCAB). There were no significant differences on mid-term mortality (pooled HR: 1.02, 95%CI: 0.89-1.17, P=0.80) and composite endpoint incidence (pooled HR: 0.98, 95%CI: 0.88-1.09, P=0.72) between OPCAB and ONCAB. At 30-day, there were no differences in mortality, myocardial infarction, stroke and renal complications. The need for early re-revascularization was significantly higher in OPCAB (pooled OR: 3.22, 95%CI: 1.28-8.09, P=0.01), with a higher percentage of incomplete revascularization being reported for OPCAB in trials included in this pooled result (34% in OPCAB vs. 29% in ONCAB, P<0.01).
CONCLUSIONS: Data from RCTs in elderly patients showed that OPCAB and ONCAB provide similar mid-term results. OPCAB was associated with a higher risk of early re-revascularization. As CABG on the elderly is still insufficiently explored, further RCTs, specifically designed targeting this population, are needed to establish a better CABG strategy for these patients.

KEY WORDS: Coronary artery bypass; Coronary artery bypass, off-pump; Aged