Off-pump versus on-pump coronary surgery in patients with chronic kidney disease: a meta-analysis

• Published in: Clinical and experimental nephrology Vol. 22; no. 1; pp. 99 - 109
• Main Authors: Wang, Yushu, Zhu, Sui, Gao, Peijuan, Zhou, Juteng, Zhang, Qing
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.02.2018; Springer Nature B.V
• Subjects: Blood transfusion; Bypass; Cerebrovascular system; Coronary artery; Coronary vessels; Fibrillation; Heart surgery; Kidney diseases; Medicine; Medicine & Public Health; Meta-analysis; Morbidity; Mortality; Myocardial infarction; Nephrology; Original Article; Quality control; Stroke; Survival; Urology; Veins & arteries; On-pump coronary artery bypass grafting; Chronic kidney disease; Off-pump coronary artery bypass grafting; Coronary heart disease
• ISSN: 1342-1751; 1437-7799; 1437-7799
• DOI: 10.1007/s10157-017-1432-7

Background Patients with chronic kidney disease (CKD) have worse adverse cardiovascular outcomes after coronary artery bypass grafting (CABG). However, the adverse cardiovascular outcomes between off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in these patients have been a subject of debate. Methods We undertook a comprehensive literature search of PubMed, Embase, and the Cochrane Library database to identify all relevant studies comparing techniques between OPCAB and ONCAB in CKD patients. We pooled the odds ratios (ORs) and hazard ratios (HRs) from individual studies and conducted heterogeneity, quality assessment, and publication bias analyses. Results This meta-analysis includes 17 studies with 201,889 patients. In CKD patients, OPCAB was associated with significantly lower early mortality as compared to ONCAB (OR 0.88; 95% CI 0.82–0.93; p  < 0.0001). OPCAB was associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI 0.34–0.97; p  = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22–0.95; p  = 0.04), blood transfusion (OR 0.20; 95% CI 0.08–0.49; p  = 0.0005), pneumonia, prolonged ventilation, and shorter hospital stays. No difference was found regarding long-term survival (HR 1.08; 95% CI 0.86–1.36; p  = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30–1.38; p  = 0.26). Conclusions Compared with ONCAB, OPCAB is associated with superior postoperative morbidity and the early mortality in CKD patients. Long-term survival is comparable between the two surgical revascularizations.