title: Does off-pump coronary artery bypass confer any advantage in patients with end-stage renal failure? A systematic review and meta-analysis.
abstract: OBJECTIVE
  Patients with end-stage renal disease (ESRD) are often excluded from trials comparing off and on-pump coronary artery bypass grafting (CABG). Thus data in this cohort is limited to small retrospective studies. Hence we compared the adverse clinical events and outcome in patients with ESRD undergoing off (OPCABG) and on-pump surgery (ONCABG).
  
  
  METHODS
  Pubmed, Scopus and Web of Science were searched (inception - June 2013) to identify studies comparing clinical results of OPCABG and ONCABG in dialysis dependent patients. A random effect inverse variance weighted meta-analysis was conducted. Results are presented as risk ratios (RR) with 95% confidence intervals; p<0.05 is significant.
  
  
  RESULTS
  Ten retrospective studies (2762 OPCABG and 11310 ONCABG) fulfilled criteria and were pooled. Patients undergoing off-pump surgery were less than 100 in most of the articles. Early mortality [OPCABG (8.4%); ONCABG (10.4%)] was comparable [RR 0.80(0.51-1.17); p=0.35; I(2)=30%]. Re-exploration for bleeding [RR 0.81(0.47-1.39); p=0.44] and blood transfusion [RR 0.79(0.57-1.08); p=0.14] were also comparable. While patients undergoing off-pump surgery were extubated earlier (p<0.01), other post-operative events like stroke (p=0.34) and atrial fibrillation (p=0.10) were similar. Mid-term survival (three to five years) was also comparable.
  
  
  CONCLUSIONS
  Patients with end-stage renal disease undergoing coronary artery bypass grafting demonstrate comparable results irrespective of method. While available data is limited to retrospective studies, we failed to demonstrate any significant advantage for performing OPCABG in this group of patients.
authors.affiliation: Asan Medical Center, Seoul, South Korea.
authors.forename: Ju Yong
authors.initials: JY
authors.lastname: Lim
authors.affiliation: Adventist Wockhardt Heart Institute, Surat Gujarat, India; Case Medical Center, Case Western Reserve University, Cleveland, OH USA. Electronic address: svd14@case.edu.
authors.forename: Salil V
authors.initials: SV
authors.lastname: Deo
authors.affiliation: Asan Medical Center, Seoul, South Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Queen Alia Heart Institute, Amman, Jordan.
authors.forename: Salah E
authors.initials: SE
authors.lastname: Altarabsheh
authors.affiliation: Mayo Clinic, Rochester, MN USA.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Dillon
authors.affiliation: Case Medical Center, Case Western Reserve University, Cleveland, OH USA.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D008297:Male; D039781:PubMed; D012307:Risk Factors; D015996:Survival Rate
keywords: Coronary artery bypass grafting; Dialysis; End-stage renal disease; Off-pump coronary artery bypass; Renal failure