Pansani Lucas Nogueira, de Paula Carvalho Pedro Emanuel, Gewehr Douglas, Taramasso Maurizio, Burkhardt Giullia, Almeidinha Lara, Ayala Rafael, Grapow Martin Tobias Robert
Department of Cardiovascular Surgery of Funfarme/Famerp, Avenue Brigadeiro Faria Lima, São José do Rio Preto, SP Postal Code 15090-000 Brazil.
Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):852-862. doi: 10.1007/s12055-025-01907-w. Epub 2025 Mar 6.
The efficacy and safety of off-pump relative to on-pump coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) remain unclear.
Conduct a meta-analysis assessing the outcomes following CABG comparing off-pump CABG vs. on-pump CABG.
MEDLINE, Cochrane, and Embase were examined for randomized controlled trials (RCTs) and observational studies that communicated outcomes after off-pump vs. on-pump CABG in patients with LMCAD. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Cochrane recommendations for quality assessment and risk of bias were performed. This study was registered in the PROSPERO platform, ID: CRD42023451467.
One RCT and 17 observational studies with 16,848 patients were included, 6735 (40.0%) of whom underwent off-pump CABG. In patients with LMCAD undergoing CABG, off-pump CABG was associated with a lower incidence of all-cause mortality (OR 0.52, 95% CI 0.38-0.71; < 0.001), acute renal dysfunction (OR 0.40; 95% CI 0.27-0.59; < 0.001), postoperative use of intra-aortic balloon pump (IABP) (OR 0.38; 95% CI 0.22-0.64; < 0.01), and wound infection (OR 0.66; 95% CI 0.48-0.9; = 0.01). There was no difference between the groups for myocardial infarction (OR 0.81; 95% CI 0.59-1.11; = 0.193), stroke, or transitional ischemic attack (TIA) (OR 0.64; 95% CI 0.38-1.06; = 0.085). The number of grafts per patient was also lower in the off-pump CABG group (mean deviation (MD) -0.32; 95% CI -0.50 to -0.14; < 0.001). After a mean follow-up of 38.1 months, no significant difference in all-cause mortality incidence was observed between the two techniques (OR 0.72; 95% CI 0.30-1.74; = 0.47). This underscores that the reduction in mortality rates was primarily driven by short-term outcomes.
In this meta-analysis with 16,848 patients with LMCAD undergoing CABG, off-pump CABG was associated with lower rates of all-cause mortality, acute renal dysfunction, IABP use, and wound infection compared with on-pump CABG.
On-pump versus off-pump CABG in patients with LMCAD.
The online version contains supplementary material available at 10.1007/s12055-025-01907-w.
在左主干冠状动脉疾病（LMCAD）患者中，非体外循环冠状动脉搭桥术（CABG）相对于体外循环冠状动脉搭桥术的疗效和安全性尚不清楚。
进行一项荟萃分析，评估比较非体外循环CABG与体外循环CABG后的CABG结局。
检索MEDLINE、Cochrane和Embase数据库，查找关于LMCAD患者非体外循环与体外循环CABG后结局的随机对照试验（RCT）和观察性研究。采用随机效应模型汇总比值比（OR）及95%置信区间（CI）。按照Cochrane质量评估和偏倚风险建议进行分析。本研究已在PROSPERO平台注册，注册号：CRD42023451467。
纳入1项RCT和17项观察性研究，共16848例患者，其中6735例（40.0%）接受非体外循环CABG。在接受CABG的LMCAD患者中，非体外循环CABG与全因死亡率较低（OR 0.52，95% CI 0.38 - 0.71；P < 0.001）、急性肾功能不全（OR 0.40；95% CI 0.27 - 0.59；P < 0.001）、术后主动脉内球囊反搏（IABP）使用（OR 0.38；95% CI 0.22 - 0.64；P < 0.01）及伤口感染（OR 0.66；95% CI 0.48 - 0.9；P = 0.01）相关。两组在心肌梗死（OR 0.81；95% CI 0.59 - 1.11；P = 0.193）、中风或短暂性脑缺血发作（TIA）（OR 0.64；95% CI 0.38 - 1.06；P = 0.085）方面无差异。非体外循环CABG组患者的移植血管数量也较少（平均差值（MD） - 0.32；95% CI - 0.50至 - 0.14；P < 0.001）。平均随访38.1个月后，两种技术在全因死亡率发生率上无显著差异（OR 0.72；95% CI 0.30 - 1.74；P = 0.47）。这强调死亡率的降低主要由短期结局驱动。
在这项对16848例接受CABG的LMCAD患者进行的荟萃分析中，与体外循环CABG相比，非体外循环CABG与较低的全因死亡率、急性肾功能不全、IABP使用及伤口感染发生率相关。
LMCAD患者的体外循环与非体外循环CABG。
在线版本包含可在10.1007/s12055 - 025 - 01907 - w获取的补充材料。
