Short- and Midterm Outcomes of Off- and On-Pump Coronary Artery Bypass in Patients with a Mean Age of 65 or More: Systematic Review and Meta-Analysis

Background. Advancing age is a nonmodifiable risk factor for the development of coronary artery disease. Furthermore, patients >65 years old are considered at high risk for coronary artery bypass grafting (CABG). The aim of this study was to investigate whether there were any differences in clinical outcomes for patients with a mean age ≥65 undergoing CABG on or off pump. Methods. Systematic searches were conducted in EMBASE, PubMed, Web of Science, and Cochrane Central Registry of Controlled Trials (CENTRAL). The key search terms used were “cardiopulmonary bypass” OR “On pump” AND “off pump” OR “beating heart” AND “coronary artery bypass grafting” OR “CABG” AND “age.” This was followed by a meta-analysis assessing the primary outcomes mortality, myocardial infarction, renal failure, and stroke in the short—(30 days) and midterm (12–44 months) and repeat revascularisation at midterm follow up. Secondary outcomes investigated included postoperative atrial fibrillation, number of units of blood transfused, ventilation time, length of intensive care unit stay, and length of hospital stay. Results. 14 studies involving 10,260 participants, 5,141 of whom had on-pump CABG and 5,119 of whom had off-pump CABG were identified. There was a significantly greater need for repeat revascularisation in the off-pump group (risk ratio 1.47, 95% confidence interval 1.07 to 2.01, I² = 0%, p = 0.02) at midterm follow up. The off-pump group also had a shorter hospital stay. All other comparisons were insignificant. Conclusion. A number of different factors contribute to whether the increased need for repeat revascularisation for off-pump patients is truly clinically significant. This requires further investigation in meta-analysis based on longer-term trials in patients with a mean age ≥65. Otherwise, the similarity in clinical outcomes for patients in this age group suggests the choice to carry out CABG on or off pump should continue to be at the surgeon’s discretion.