ISMICS consensus conference and statements of randomized controlled trials of off-pump versus conventional coronary artery bypass surgery

John D. Puskas, Janet Martin, Davy C H Cheng, Stefano Benussi, Johannes O. Bonatti, Anno Diegeler, Francis D. Ferdinand, Teresa M. Kieser, Andre Lamy, Michael J. Mack, Nirav C. Patel, Marc Ruel, Joseph F. Sabik, Bobby Yanagawa, Vipin Zamvar

Research output: Contribution to journalArticle

Abstract

Objective: At this consensus conference, we developed evidenceinformed consensus statements and recommendations on the practice of off-pump coronary artery bypass graft (OPCAB) by systematically reviewing and performing meta-analysis of the randomized controlled trials (RCTs) comparing OPCAB and conventional coronary artery bypass (CCAB). Methods: All RCTs of OPCAB versus CCAB through April 2013 were screened, and 102 relevant RCTs (19, 101 patients) were included in a systematic review and meta-analysis (15 RCTs of 9551 high-risk patients; and 87 RCTs of 9550 low-risk patients) in accordance with the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Consensus statements for the risks and benefits of OPCAB surgery in mortality, morbidity, and resource use were developed based on best available evidence. Results: Compared to CCAB, it is reasonable to perform OPCAB to reduce risks of stroke [class IIa, level of evidence (LOE) A], renal dysfunction/failure (class IIa, LOE A), blood transfusion (class I, LOE A), respiratory failure (class I, LOE A), atrial fibrillation (class I, LOE A), wound infection (class I, LOE A), ventilation time, and ICU and hospital length of stay (class I, LOE A). However, OPCAB may be associated with a reduced number of grafts performed (class I, LOE A) and with diminished graft patency (class IIa, LOE A, with increased coronary reintervention at 1 year and beyond (class IIa, LOE A), aswell as increased mortality at a median follow-up of 5 years (class IIb, LOE A). Conclusions: OPCAB compared with CCAB may improve outcomes in the short-term (stroke, renal dysfunction, blood transfusion, respiratory failure, atrial fibrillation, wound infection, ventilation time, and length of stay). However, over the longer-term, OPCAB may be associated with reduced graft patency, and increased risk of cardiac re-intervention and death.

Original languageEnglish
Pages (from-to)219-229
Number of pages11
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume10
Issue number4
Publication statusPublished - Sep 1 2015

Fingerprint

Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Randomized Controlled Trials
Transplants
Meta-Analysis
Length of Stay
Wound Infection
Blood Transfusion
Respiratory Insufficiency
Atrial Fibrillation
Ventilation
Stroke
Mortality
Renal Insufficiency
Morbidity
Kidney

Keywords

  • Consensus statement
  • ISMICS
  • Off-pump coronary artery bypass grafting
  • Randomized controlled trials
  • Surgical revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

ISMICS consensus conference and statements of randomized controlled trials of off-pump versus conventional coronary artery bypass surgery. / Puskas, John D.; Martin, Janet; Cheng, Davy C H; Benussi, Stefano; Bonatti, Johannes O.; Diegeler, Anno; Ferdinand, Francis D.; Kieser, Teresa M.; Lamy, Andre; Mack, Michael J.; Patel, Nirav C.; Ruel, Marc; Sabik, Joseph F.; Yanagawa, Bobby; Zamvar, Vipin.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 10, No. 4, 01.09.2015, p. 219-229.

Research output: Contribution to journalArticle

Puskas, JD, Martin, J, Cheng, DCH, Benussi, S, Bonatti, JO, Diegeler, A, Ferdinand, FD, Kieser, TM, Lamy, A, Mack, MJ, Patel, NC, Ruel, M, Sabik, JF, Yanagawa, B & Zamvar, V 2015, 'ISMICS consensus conference and statements of randomized controlled trials of off-pump versus conventional coronary artery bypass surgery', Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, vol. 10, no. 4, pp. 219-229.
Puskas, John D. ; Martin, Janet ; Cheng, Davy C H ; Benussi, Stefano ; Bonatti, Johannes O. ; Diegeler, Anno ; Ferdinand, Francis D. ; Kieser, Teresa M. ; Lamy, Andre ; Mack, Michael J. ; Patel, Nirav C. ; Ruel, Marc ; Sabik, Joseph F. ; Yanagawa, Bobby ; Zamvar, Vipin. / ISMICS consensus conference and statements of randomized controlled trials of off-pump versus conventional coronary artery bypass surgery. In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2015 ; Vol. 10, No. 4. pp. 219-229.
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T1 - ISMICS consensus conference and statements of randomized controlled trials of off-pump versus conventional coronary artery bypass surgery

AU - Puskas, John D.

AU - Martin, Janet

AU - Cheng, Davy C H

AU - Benussi, Stefano

AU - Bonatti, Johannes O.

AU - Diegeler, Anno

AU - Ferdinand, Francis D.

AU - Kieser, Teresa M.

AU - Lamy, Andre

AU - Mack, Michael J.

AU - Patel, Nirav C.

AU - Ruel, Marc

AU - Sabik, Joseph F.

AU - Yanagawa, Bobby

AU - Zamvar, Vipin

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Objective: At this consensus conference, we developed evidenceinformed consensus statements and recommendations on the practice of off-pump coronary artery bypass graft (OPCAB) by systematically reviewing and performing meta-analysis of the randomized controlled trials (RCTs) comparing OPCAB and conventional coronary artery bypass (CCAB). Methods: All RCTs of OPCAB versus CCAB through April 2013 were screened, and 102 relevant RCTs (19, 101 patients) were included in a systematic review and meta-analysis (15 RCTs of 9551 high-risk patients; and 87 RCTs of 9550 low-risk patients) in accordance with the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Consensus statements for the risks and benefits of OPCAB surgery in mortality, morbidity, and resource use were developed based on best available evidence. Results: Compared to CCAB, it is reasonable to perform OPCAB to reduce risks of stroke [class IIa, level of evidence (LOE) A], renal dysfunction/failure (class IIa, LOE A), blood transfusion (class I, LOE A), respiratory failure (class I, LOE A), atrial fibrillation (class I, LOE A), wound infection (class I, LOE A), ventilation time, and ICU and hospital length of stay (class I, LOE A). However, OPCAB may be associated with a reduced number of grafts performed (class I, LOE A) and with diminished graft patency (class IIa, LOE A, with increased coronary reintervention at 1 year and beyond (class IIa, LOE A), aswell as increased mortality at a median follow-up of 5 years (class IIb, LOE A). Conclusions: OPCAB compared with CCAB may improve outcomes in the short-term (stroke, renal dysfunction, blood transfusion, respiratory failure, atrial fibrillation, wound infection, ventilation time, and length of stay). However, over the longer-term, OPCAB may be associated with reduced graft patency, and increased risk of cardiac re-intervention and death.

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KW - Consensus statement

KW - ISMICS

KW - Off-pump coronary artery bypass grafting

KW - Randomized controlled trials

KW - Surgical revascularization

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