TDNet Discover

: Medical procedures have been greatly improved over the past few decades. Onpump Coronary Artery Bypass Graft (CABG) and off-pump CABG procedures are both effective means for revascularization of cardiac tissue secondary to coronary artery blockages. An offpump CABG procedure became more popular in the 1990’s, which is newer in comparison to an on-pump CABG procedure. Objective: The purpose in performing this research was to determine which method of revascularization was superior when examining on-pump CABG procedures and off-pump CABG procedures. Determining which procedure is superior could have many benefits for patients and hospitals. These benefits can range anywhere from reduced economic burdens on patients and hospitals, to the patient being in greater overall health following a revascularization procedure. Methods: Using predetermined search terms, researchers completed a thorough search of current literature in Pubmed, Medline, and Discover Search. The following limits were implemented to narrow the search field: written in English, full text articles, articles that were peer reviewed, articles that had been published within the past five years, and articles that only looked at procedures that were performed on humans. After reading the abstracts and imposing inclusion and exclusion criteria to the remaining articles, ten articles were still in contention. Researchers read the ten articles and performed quality assessment to select the three meta-analyses that best addressed the research question. Results: Three meta-analyses were thoroughly studied totaling 43,734 patients. In the study that looked at a comparison of on- versus off-pump CABG at 4 years post-op, there was a significantly lower incidence of mortality in the on-pump group. The incidences of angina, OFF-PUMP VERSUS ON-PUMP CABG SURGERY iv myocardial infarction (MI), revascularization and stroke were similar. Another study focused on results within 1-month post-op and revealed incidences of decreased cardiac output two-fold with the use of on-pump and a 2.1% reduction in renal dysfunction with off-pump method. There was no difference between the two methods regarding mortality, post-op MI, or stroke. The last meta-analysis specifically looked at octogenarian’s post-op which displayed a significantly lower rate of in hospital mortality and hospital stay in the off-pump group. There was no difference in MI, renal failure, or rates of atrial fibrillation. Conclusion: This research study concluded that the on-pump method has superior long-term outcomes compared to the off-pump method even though both methods have their advantages for coronary artery revascularization. Ultimately, the more appropriate procedure is chosen on a case by case basis, in which certain patients would benefit more from an on-pump CABG and other patients would benefit more from an off-pump CABG. This should be determined by the patient and the skill set of each cardiothoracic surgeon.