TY - JOUR
T1 - Miniaturized extracorporeal circulation versus off-pump coronary artery bypass grafting
T2 - A meta-analysis of randomized controlled trials
AU - Benedetto, Umberto
AU - Ng, Colin
AU - Frati, Giacomo
AU - Biondi-Zoccai, Giuseppe
AU - Vitulli, Piergiusto
AU - Zeinah, Mohamed
AU - Raja, Shahzad G.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background: Controversies exist whether off-pump coronary artery bypass (OPCAB) is superior to miniaturized extracorporeal circulation (MECC) in reducing deleterious effects of cardiopulmonary bypass as only a number of smaller randomized controlled trials (RCT) currently provide a limited evidence base. The main purpose of conducting the present meta-analysis was to overcome the expected low power in RCTs in an attempt to establish whether MECC is comparable to OPCAB. Methods: A MEDLINE/PubMed search was conducted to identify eligible RCTs. A pooled summary effect estimate was calculated by means of Mantel-Haenszel method. Results: The search yielded 7 RCTs included in this meta-analysis enrolling 271 patients in the OPCAB group and 279 in the MECC group. The OPCAB and MECC groups were comparable in terms of incidence of in-hospital mortality (Risk Difference [RD] 0.01; 95%CI -0.02, 0.03; P=0.55; I2=0%), stroke (RD -0.01; 95%CI -0.05, 0.04; P=0.69; I2=0%), need for renal replacement therapy (RD 0.00; -0.06, 0.06; P=1; I2=0%), postoperative atrial fibrillation (RD -0.03; -0.17, 0.10; P=0.64; I2=0%), re-exploration for bleeding (RD -0.01; 95%CI -0.03, 0.02; P=0.65; I2=0%), transfusion rate (RD -0.01; 95%CI -0.03, 0.02; P=0.65; I2=0%) and the amount of blood loss (weighted mean difference -25mL; 95%CI -71, 21; P=0.28; I2=0%). Conclusions: Using a meta-analytic approach, MECC achieves clinical results comparable to OPCAB including postoperative blood loss and blood transfusion requirement. On the basis of our findings, MECC should be considered as a valid alternative to OPCAB in order to reduce surgical morbidity of conventional cardiopulmonary bypass.
AB - Background: Controversies exist whether off-pump coronary artery bypass (OPCAB) is superior to miniaturized extracorporeal circulation (MECC) in reducing deleterious effects of cardiopulmonary bypass as only a number of smaller randomized controlled trials (RCT) currently provide a limited evidence base. The main purpose of conducting the present meta-analysis was to overcome the expected low power in RCTs in an attempt to establish whether MECC is comparable to OPCAB. Methods: A MEDLINE/PubMed search was conducted to identify eligible RCTs. A pooled summary effect estimate was calculated by means of Mantel-Haenszel method. Results: The search yielded 7 RCTs included in this meta-analysis enrolling 271 patients in the OPCAB group and 279 in the MECC group. The OPCAB and MECC groups were comparable in terms of incidence of in-hospital mortality (Risk Difference [RD] 0.01; 95%CI -0.02, 0.03; P=0.55; I2=0%), stroke (RD -0.01; 95%CI -0.05, 0.04; P=0.69; I2=0%), need for renal replacement therapy (RD 0.00; -0.06, 0.06; P=1; I2=0%), postoperative atrial fibrillation (RD -0.03; -0.17, 0.10; P=0.64; I2=0%), re-exploration for bleeding (RD -0.01; 95%CI -0.03, 0.02; P=0.65; I2=0%), transfusion rate (RD -0.01; 95%CI -0.03, 0.02; P=0.65; I2=0%) and the amount of blood loss (weighted mean difference -25mL; 95%CI -71, 21; P=0.28; I2=0%). Conclusions: Using a meta-analytic approach, MECC achieves clinical results comparable to OPCAB including postoperative blood loss and blood transfusion requirement. On the basis of our findings, MECC should be considered as a valid alternative to OPCAB in order to reduce surgical morbidity of conventional cardiopulmonary bypass.
KW - Meta-analysis
KW - Minimized extracorporeal circulation
KW - Off-pump coronary artery bypass grafting
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U2 - 10.1016/j.ijsu.2014.12.021
DO - 10.1016/j.ijsu.2014.12.021
M3 - Article
C2 - 25560750
AN - SCOPUS:84922823787
VL - 14
SP - 96
EP - 104
JO - International Journal of Surgery
JF - International Journal of Surgery
SN - 1743-9191
ER -