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Ann Thorac Surg 2006;82:770-771
© 2006 The Society of Thoracic Surgeons

Correspondence

Reply

Alessandro Parolari, MD, PhD, Francesco Alamanni, MD, Fabrizio Veglia, PhD, Elena Tremoli, PhD, Paolo Biglioli, MD

Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, via Parea 4, Milan, 20138 Italy

To the Editor:

We thank Takagi and colleagues [1] for their interest in our article. However, their criticism concerning the appropriate use of odds ratio (instead of relative risk) is minor, as the use of odds ratio as a measure of relative effect is a totally acceptable method for describing a treatment effect [2].

Also their concerns about robustness of our analysis can be easily ruled out. First, our strategy to address the potential heterogeneity coming from one of the included studies [3], which was one of the two articles included in "Low quality studies," was to repeat the analysis by excluding this study (a clear outlier at funnel plot), as recommended by Cochrane world-accepted guidelines [2]. In addition, it is obvious that in this case, as at this point only one study remained in the "Low quality studies" subsection, there was no more rationale for performing separate analyses between low-quality and high-quality studies. And only the pooled analysis of all the studies, which in our opinion is by far the most informative one, had sense in this case.

Second, also after the exclusion of the "outlier" article [3], the analysis of the data, both with random-effect and fixed-effect models, provided a statistically significant difference in patency rates between on-pump and off-pump coronary bypass surgery, as we stated and published in our article [4].

Third, even after the exclusion of this article [3], all the remaining 4 studies were exceptionally homogeneous in the effect estimation as previously reported [4].

Fourth, since the submission and publication of our article another prospective randomized study reporting patency data in on-pump and off-pump coronary surgery has been published in the literature [5]. Also the pooled analysis of the articles selected in our previous study plus this recently published article confirms the increased risk of graft failure in patients undergoing off-pump coronary surgery (odds ratio = 1.56; 95% confidence interval = 1.20–2.02; p = 0.0008) [6].

Unfortunately the problem of reduced conduit patency in off-pump coronary bypass surgery is here to stay.


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 References
 

  1. Takagi H, Sugimoto M, Kato T, Matsuno Y, Umemoto T. Does off-pump coronary artery bypass graft surgery increase risk of graft occlusion?(letter) Ann Thorac Surg 2006;82:769-770.[Free Full Text]
  2. Deeks JJ, Higgins JPT, Altman DG, eds. Analysing and presenting results. In: Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]; Section 8; http://www.cochrane.org/resources/handbook/hbook.htm (accessed January 30, 2006)..
  3. Khan NE, De Souza A, Mister R, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery N Engl J Med 2004;350:21-28.[Abstract/Free Full Text]
  4. Parolari A, Alamanni F, Polvani G, et al. Meta-analysis of randomized trials comparing off-pump with on-pump coronary artery bypass graft patency Ann Thorac Surg 2005;80:2121-2125.[Abstract/Free Full Text]
  5. Kobayashi J, Tashiro T, Ochi M, et al. Early outcome of a randomized comparison of off-pump and on-pump multiple arterial coronary revascularization Circulation 2005;112(Suppl I):I338-I343.
  6. Parolari A, Alamanni F, Polvani G, et al. Chirurgia coronarica a cuore battentestato attuale delle evidenze. G Ital Cardiol 2006(in press).



This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. Parolari, E. Tremoli, M. Fusari, and P. Biglioli
Off-pump coronary bypass surgery, graft patency, and the need of an informed consent
J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1687 - 1687.
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