Off-pump CABG linked to increased mortality risk
MedWire News: Off-pump coronary artery bypass graft (CABG) surgery may carry an increased risk for mortality, a systematic review by Cochrane researchers shows.
"Our data raise a warning regarding CABG surgery performed while the heart is still beating," said lead researcher Christian Møller (The Copenhagen University Hospital, Denmark) in a press statement.
"By comparison, the traditional on-pump method seems less risky and, based on the evidence, should remain the standard surgical treatment."
The review included 86 trials and 10,716 patients. Pooled analysis of all trials showed that off-pump CABG was associated with increased all-cause mortality compared with on-pump CABG, at 3.7% versus 3.1%, corresponding to a risk ratio of 1.24 (p=0.04).
However, the researchers found that the majority of these trials had a high risk for bias. They therefore conducted a separate analysis of ten trials that had a low risk for bias.
Interestingly, in this analysis, the association between off-pump CABG and all-cause mortality was even more pronounced, with the mean rate of death over a mean follow-up of 6.2% versus 4.6%, corresponding to a risk ratio of 1.35 (p=0.01).
There was no significant difference between on-pump and off-pump CABG in terms of rates of myocardial infarction, stroke, renal insufficiency, or coronary re-intervention.
Compared with on-pump CABG, off-pump CABG reduced post-operative atrial fibrillation. However, in trials at low risk for bias, this effect was no longer significant.
Although improved survival was observed in patients undergoing on-pump CABG, the group recommends that off-pump CABG may be acceptable in patients for whom there are contraindications for cannulation of the aorta and cardiopulmonary bypass.
"We need more trials assessing the potential benefit of beating heart approaches in patients with contraindications to on-pump surgery," said Møller. "In these patients, off-pump could still be considered."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Piriya Mahendra