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Ann Thorac Surg 2003;76:37-40
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials

Alessandro Parolari, MD, PhDa*, Francesco Alamanni, MDa, Aldo Cannata, MDa, Moreno Naliato, MDa, Luigi Bonati, MDb, Patrizia Rubini, MD, PhDb, Fabrizio Veglia, PhDc, Elena Tremoli, PhDa, Paolo Biglioli, MDa

a Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Milan Italy
b Institute of General Surgery and Organ Transplantation, University of Parma, Parma, Italy
c Biostatistics Unit, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy

Accepted for publication January 17, 2003.

* Address reprint requests to Dr Parolari, Department of Cardiac Surgery, University of Milan, Centro Cardiologico Monzino IRCCS, Via Parea, 4, 20138, Milan, Italy
e-mail: aparolari{at}cardiologicomonzino.it

BACKGROUND: Off-pump coronary artery bypass (OPCAB) challenges the conventional on-pump coronary artery bypass grafting (CABG) as the standard of surgical therapy for coronary disease. The aim of this study is to assess the differences in clinical outcomes between CABG and OPCAB by meta-analysis of data published in randomized trials.

METHODS: A literature search (Medline, Pubmed, Cochrane Controlled Trials Register, and the Cochrane Medical Editors Trial Amnesty of unpublished clinical trials) was done for the period starting from January 1990 until May 2002 and was supplemented with a manual bibliographic review for all peer-reviewed English language publications. A systematic overview (meta-analysis) of the randomized trials was done to define the risk of the composite end point (death, stroke, or myocardial infarction) in CABG versus OPCAB.

RESULTS: A literature search yielded nine comparable randomized studies, for a total of 1090 patients, of whom 558 and 532 were randomly assigned to CABG and OPCAB, respectively. Meta-analysis of these studies showed a trend, albeit not statistically significant, toward reduction in the risk of the composite end point for patients who had OPCAB (odds ratio 0.48; 95% confidence interval 0.21 to 1.09; p = 0.08).

CONCLUSIONS: Cumulative analysis of the few prospective randomized studies currently available found a potential clinical benefit of OPCAB, indicating that the avoidance of extracorporeal circulation might result in improved clinical outcomes. Further evidence, however, from large randomized trials is needed to assess potential advantages of OPCAB in terms of early outcomes.




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