The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 4 , Pages 829-835.e13, October 2010

Off-pump versus on-pump coronary artery bypass grafting: A systematic review and meta-analysis of propensity score analyses

  • Oliver Kuss, PhD

      Affiliations

    • Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, University of Halle-Wittenberg, Halle (Saale), Germany
    • Corresponding Author InformationAddress for reprints: Oliver Kuss, PhD, Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, University of Halle-Wittenberg, Magdeburger Str 8, 06097 Halle (Saale), Germany.
    • ,
  • Benita von Salviati, MS

      Affiliations

    • Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, University of Halle-Wittenberg, Halle (Saale), Germany
    • ,
  • Jochen Börgermann, MD

      Affiliations

    • Heart and Diabetes Center North Rhine-Westphalia, Department of Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany

Received 28 April 2009; received in revised form 30 July 2009; accepted 9 December 2009. published online 18 February 2010.

Objective

Despite numerous randomized and nonrandomized trials on off- and on-pump coronary artery bypass grafting, it remains open which method is superior. Patient selection and small sample sizes limit the evidence from randomized trials; lack of randomization limits the evidence from nonrandomized trials. Propensity score analyses are expected to improve on at least some of these problems. We aimed to systematically review all propensity score analyses comparing off- and on-pump coronary artery bypass grafting.

Methods

Propensity score analyses comparing off- and on-pump surgery were identified from 8 bibliographic databases, citation tracking, and a free web search. Two independent reviewers abstracted data on 11 binary short-term outcomes.

Results

A total of 35 of 58 initially retrieved propensity score analyses were included, accounting for a total of 123,137 patients. The estimated overall odds ratio was less than 1 for all outcomes, favoring off-pump surgery. This benefit was statistically significant for mortality (odds ratio, 0.69; 95% confidence interval, 0.60–0.75), stroke, renal failure, red blood cell transfusion (P < .0001), wound infection (P < .001), prolonged ventilation (P < .01), inotropic support (P = .02), and intraaortic balloon pump support (P = .05). The odds ratios for myocardial infarction, atrial fibrillation, and reoperation for bleeding were not significant.

Conclusions

Our systematic review and meta-analysis of propensity score analyses finds off-pump surgery superior to on-pump surgery in all of the assessed short-term outcomes. This advantage was statistically significant and clinically relevant for most outcomes, especially for mortality, the most valid criterion. These results agree with previous systematic reviews of randomized and nonrandomized trials.

CTSNet classification: 23.1, 24

Abbreviations and Acronyms: CABG, coronary artery bypass grafting, CI, confidence interval, OR, odds ratio, RBC, red blood cell, RCT, randomized clinical trial

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Disclosures: Jochen Börgermann (as the principal investigator) and Oliver Kuss conducted a randomized trial to compare off-pump with on-pump coronary artery bypass grafting, which was sponsored in part by a grant from Medtronic, Düsseldorf, Germany. There was no external funding of the project reported, and all authors report no further conflicts of interest.

PII: S0022-5223(09)01625-0

doi:10.1016/j.jtcvs.2009.12.022

The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 4 , Pages 829-835.e13, October 2010

Article Tools

* Image Usage & Resolution