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A meta-analysis of randomized controlled studies comparing off-pump vs on-pump CABG in the elderly
Session:
Prémio Machado Macedo/ CO 15- Cardiac Surgery
Speaker:
Rui j. Machado
Congress:
CPC 2021
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Prémios
FP Number:
---
Authors:
Rui j. Machado; Francisca a. Saraiva; Patrícia Sousa; Rui j. Cerqueira; Jennifer Mancio; António s. Barros; André p. Lourenço; Adelino f. Leite-Moreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Introduction and objectives</strong>: Aging and the increasing demand for less invasive open heart surgical procedures have augmented interest in off-pump CABG as an option in elderly patients. We performed a meta-analysis of randomized clinical trials (RCTs) to investigate the benefits of off-pump CABG (OPCAB) over on-pump CABG (ONCAB) in short and mid-term results among patients older than 60.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Methods:</strong> MEDLINE, ISI Web of Science and Cochrane Library were used to find relevant literature (1960-2020). RCTs of OPCAB vs ONCAB within elderly patients (or at least with an elderly subgroup analysis) and that reported mortality either early or during follow-up were included. Myocardial infarction, stroke, repeat revascularization and renal failure were also evaluated, if available. Time-to-event outcomes were collected through hazard ratio (HR) along with their variance and the early endpoints using frequencies or odds ratio (OR). Random effect models were used to compute statistical combined measures and 95% confidence intervals (CI). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Results</strong>: We included 9 RCTs, performing a total of 7,046 elderly patients: 3,528 OPCAB and 3,518 ONCAB, 51% being males. Five trials reported mortality during follow-up (6 months (2 studies) to 5.3 years). OPCAB did not impact follow-up mortality (pooled HR: 1.08, 95%CI: 0.86-1.34, p=0.52). Regarding early results, OPCAB showed similar 30-days mortality (2.3% vs 2.6% in OPCAB vs ONCAB patients, respectively, 6 studies pooled OR: 0.89, 95%CI: 0.61-1.29, p=0.53); early myocardial infarction (3.1% vs 3.0% in OPCAB vs ONCAB patients, respectively, 6 studies pooled OR: 0.99, 95%CI: 0.67-1.46, p=0.95); and renal failure (2.6% vs 3.4% in OPCAB vs ONCAB, 5 studies pooled OR: 0.77, 95%CI: 0.53-1.11, p=0.16). The early need for repeat revascularization was significantly higher in OPCAB (1.3% vs 0.4% in OPCAB vs ONCAB, 2 studies pooled OR: 2.58, 95%CI: 1.16-5.75, p=0.02). Of note, OPCAB had a higher risk of incomplete revascularization (34% vs 29% in OPCAB vs ONCAB, respectively, pooled OR in both trials included in repeat revascularization result: 1.24, 95%CI: 1.06-1.45, p<0.01). On the other side, OPCAB had a non-significant lower risk of early stroke (1.9% vs 2.7% in OPCAB vs ONCAB patients, respectively, 7 studies pooled OR: 0.72, 95%CI: 0.42-1.05, p=0.09).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Conclusions</strong>: Pooling data from RCTs in elderly patients showed that OPCAB and ONCAB provide similar mid-term results. Concerning early outcomes, OPCAB was associated with a higher risk of early repeat revascularization. Further studies with larger elderly samples are needed to establish the better surgical strategy for these patients. </span></span></p>
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