HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eric Lim Andrew Drain William Davies Bruce R. Rosengard Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lim, E. Articles by Rosengard, B. R. Search for Related Content PubMed PubMed Citation Articles by Lim, E. Articles by Rosengard, B. R.

J Thorac Cardiovasc Surg 2006;132:1409-1413
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

A systematic review of randomized trials comparing revascularization rate and graft patency of off-pump and conventional coronary surgery

^a Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
^b Library and Knowledge Services, Papworth Hospital, Cambridge, United Kingdom.

Presented to the Society of Cardiothoracic Surgeons of Great Britain and Ireland Annual Meeting, Dublin, Ireland, March 14, 2006.

Received for publication June 15, 2006; revisions received July 24, 2006; accepted for publication August 8, 2006.

^_* Address for reprints: Mr Eric Lim, Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, United Kingdom. (Email: eric.lim{at}cvsnet.org).

OBJECTIVE: Although many trials have been conducted to evaluate the benefits of off-pump coronary surgery, few have concentrated on graft patency. We sought to evaluate the impact of off-pump surgery on completeness of revascularization and graft patency compared with conventional surgery.

METHODS: A systematic literature search was undertaken of all randomized trials of off-pump coronary surgery in MEDLINE, EMBASE, the Cochrane Library Controlled Trials Register, the National Research Register, and abstracts from major conferences.

RESULTS: In total, 132 publications were identified. From this number, we excluded 43 without a conventional surgery arm and 80 that did not evaluate graft patency. One trial was excluded for selective angiography and one abstract was excluded because of insufficient information. A total of 7 trials were eligible for overview. On initial analysis, the relative risk of graft patency in off-pump coronary surgery compared with conventional surgery was 0.959 (95% confidence interval 0.936-0.983; P = .001). The analysis was repeated after excluding one specific trial because of clinical and statistical heterogeneity (² ₆ = 27.78; P < .001), and a relative risk of 0.953 (95% confidence interval 0.927-0.980; P = .001) was obtained with no further evidence of heterogeneity (² ₅ = 5.35; P = .374). In 5 trials that included the mean number of grafts performed per arm, the standardized mean difference in revascularization comparing off-pump with conventional surgery was –0.164 (–0.286 to –0.043; P = .008).

CONCLUSION: In a meta-analysis of randomized trials, patients undergoing off-pump coronary surgery had a lower rate of revascularization and lower graft patency than did patients undergoing conventional coronary surgery.

This article has been cited by other articles:

				G. F.V. Panday, S. Fischer, A. Bauer, D. Metz, J. Schubel, N. E. Shouki, T. Eberle, and H. Hausmann Minimal extracorporeal circulation and off-pump compared to conventional cardiopulmonary bypass in coronary surgery Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 832 - 836. [Abstract] [Full Text] [PDF]

				P. H. Desai, D. Kurian, N. Thirumavalavan, S. P. Desai, P. Ziu, M. Grant, C. White, R. C. Landis, and R. S. Poston A Randomized Clinical Trial Investigating the Relationship Between Aprotinin and Hypercoagulabilityin Off-Pump Coronary Surgery Anesth. Analg., November 1, 2009; 109(5): 1387 - 1394. [Abstract] [Full Text] [PDF]

				Y. Abu-Omar and D. P. Taggart The present status of off-pump coronary artery bypass grafting Eur. J. Cardiothorac. Surg., August 1, 2009; 36(2): 312 - 321. [Abstract] [Full Text] [PDF]

				X. Sun, R. M. Lim, P. C Hill, E. Haile, P. J Corso, and J. M Garcia Current Practice and Outcomes of Off-pump Multivessel Coronary Artery Bypass Asian Cardiovasc Thorac Ann, August 1, 2009; 17(4): 362 - 367. [Abstract] [Full Text] [PDF]

				T. Shimokawa, S. Manabe, T. Sawada, S. Matsuyama, T. Fukui, and S. Takanashi Intermediate-term patency of saphenous vein graft with a clampless hand-sewn proximal anastomosis device after off-pump coronary bypass grafting. Ann. Thorac. Surg., May 1, 2009; 87(5): 1416 - 1420. [Abstract] [Full Text] [PDF]

				H. B. Ward, R. F. Kelly, and E. K. Weir Assessment of graft patency during coronary artery bypass graft surgery mitigating the risk. J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 613 - 615. [Full Text] [PDF]

				A. Parolari, E. Tremoli, P. Biglioli, and F. Alamanni Off-pump coronary bypass surgery: another brick in the wall of reduced graft patency. Ann. Thorac. Surg., February 1, 2009; 87(2): 675 - 676. [Full Text] [PDF]

				G. D. Angelini, L. Culliford, D. K. Smith, M. C.K. Hamilton, G. J. Murphy, R. Ascione, A. Baumbach, and B. C. Reeves Effects of on- and off-pump coronary artery surgery on graft patency, survival, and health-related quality of life: long-term follow-up of 2 randomized controlled trials. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 295 - 303. [Abstract] [Full Text] [PDF]

				M. C. Grant, Z. Kon, A. Joshi, E. Christenson, S. Kallam, N. Burris, J. Gu, and R. S. Poston Is Aprotinin Safe to Use in a Cohort at Increased Risk for Thrombotic Events: Results From a Randomized, Prospective Trial in Off-Pump Coronary Artery Bypass Ann. Thorac. Surg., September 1, 2008; 86(3): 815 - 822. [Abstract] [Full Text] [PDF]

				M. J. Synnergren, R. Ekroth, A. Oden, H. Rexius, and L. Wiklund Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: Role of off-pump surgery J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 29 - 36. [Abstract] [Full Text] [PDF]

				H. B. Barner Operative Treatment of Coronary Atherosclerosis Ann. Thorac. Surg., April 1, 2008; 85(4): 1473 - 1482. [Abstract] [Full Text] [PDF]

				K.-B. Kim, K. R. Cho, and D. S. Jeong Midterm angiographic follow-up after off-pump coronary artery bypass: serial comparison using early, 1-year, and 5-year postoperative angiograms. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 300 - 307. [Abstract] [Full Text] [PDF]

				K. R. Cho, D. S. Jeong, and K.-B. Kim Influence of vein graft use on postoperative 1-year results after off-pump coronary artery bypass surgery Eur. J. Cardiothorac. Surg., November 1, 2007; 32(5): 718 - 723. [Abstract] [Full Text] [PDF]

				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. [Full Text] [PDF]

				H. Takagi, T. Kato, and T. Umemoto Lower graft patency in off-pump compared with conventional coronary surgery J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1391 - 1391. [Full Text] [PDF]

				E. Lim Reply to the Editor J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1392 - 1392. [Full Text] [PDF]

				H. Takagi, T. Kato, and T. Umemoto Off-pump coronary artery bypass sacrifices graft patency J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1394 - 1395. [Full Text] [PDF]