Off-pump coronary surgery: An updated systematic review and meta-analysis

Introduction and objectives: After 30 years, off-pump coronary artery bypass grafting benefits are still controversial when compared with the on-pump technique. For this reason, a meta-analysis is presented that compares the early and long-term results of the 2 surgical strategies. Methods: A search was made of PubMed, EMBASE, and the Cochrane library database for clinical trials up to December 2017 for randomised clinical trials investigating off-pump versus on-pump coronary surgery with sample size of >= 100 patients. Results: A total of 34 clinical trials, with a total of 16,435 patients and 9643 examined grafts were included in this meta-analysis. Off-pump surgery achieved similar 30-day and 1-year mortality compared with on-pump surgery. The off-pump technique significantly decreased the risk of 30-day stroke (RR 0.73; 95% CI; 0.57-0.94; p=0.015), but it increases 1-year repeat revascularization risk (RR 1.52; 95% CI; 1.18-1.96; p=0.001), 5-year mortality risk (RR= 1.15; 95% CI; 1.03-1.29; p=0.012) and it is associated with worse graft patency (RR 0.97; 95% CI; 0.94-0.99; p=0.007) compared with on-pump surgery. Conclusions: Off-pump coronary surgery may provide better short-term neurological results compared with the on-pump technique, at the expense of a worse graft patency, increased risk of 1-year repeat revascularisation, and of 5-years mortality. (C) 2019 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U.