Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting?
BACKGROUND
Atrial fibrillation is the most common postoperative complication in patients undergoing coronary artery bypass grafting (CABG) with advancing age having been shown to have a significant association with its incidence. This study aims to assess whether off-pump coronary artery bypass (OPCAB) reduces the incidence of atrial fibrillation in elderly patients.


METHODS
A meta-analysis of all observational studies reporting a comparison between the two techniques in elderly patients (> 70 years) between 1999-2003 was performed. The primary outcome of interest was the incidence of postoperative atrial fibrillation. The quality of each study was evaluated by examining three items: patient selection, matching of the off-pump and cardiopulmonary bypass patient groups, and assessment of outcome. Meta-regression analysis was undertaken to see the effects of study size and quality on the calculated odds ratio.


RESULTS
Eight studies fulfilled our inclusion criteria, all of which were nonrandomized. In total the studies identified 3017 subjects, of which 764 had off-pump surgery (25%) and 2253 underwent cardiopulmonary bypass (75%). Meta-analysis showed that after off-pump surgery there was a significantly lower incidence of postoperative atrial fibrillation in these patients (odds ratio 0.70, 95% confidence interval [CI] 0.56-0.89). Meta-regression analysis including study characteristics did not show any associations affecting the calculated odds ratio of atrial fibrillation.


CONCLUSIONS
Our study demonstrates a reduced incidence of postoperative atrial fibrillation in an elderly population with off-pump as compared with cardiopulmonary bypass techniques. We appreciate, however, that our statistical analysis uses nonrandomized published data and that the results must be treated with caution. If this finding is confirmed by a large-scale randomized trial, it has significant implications on the operative strategy employed for this patient group.
Athanasiou
Thanos
T
The National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Department of Cardiothoracic Surgery, St. Mary's Hospital and Royal Brompton Hospital, London, United Kingdom. tathan5253@aol.com
Aziz
Omer
O
Mangoush
Omar
O
Weerasinghe
Arjuna
A
Al-Ruzzeh
Sharif
S
Purkayastha
Sanjay
S
Pepper
John
J
Amrani
Mohamed
M
Glenville
Brian
B
Casula
Roberto
R
D000368:Aged; D001281:Atrial Fibrillation / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D011184:Postoperative Period; D012086:Reoperation; D012307:Risk Factors