title: Off-pump coronary artery bypass reduces early stroke in octogenarians: a meta-analysis of 18,000 patients.
abstract: BACKGROUND
  Data comparing results of off-pump and conventional operations in octogenarians is very limited. Thus we chose to compare early adverse events between off-pump coronary artery bypass grafting (OPCABG) and on-pump CABG (ONCABG) in patients older than 80 years.
  
  
  METHODS
  Systematic review of multiple databases was performed to obtain original studies fulfilling search criteria. End points--early mortality, stroke, respiratory failure, atrial fibrillation, and myocardial infarction--were compared between these cohorts. A random-effects weighted analysis was performed using the trim-fill adjustment when necessary. Results are presented as risk ratios (RRs) with 95% confidence intervals (CIs); p < 0.05 is considered statistically significant.
  
  
  RESULTS
  Sixteen retrospective studies (9,744 ONCABG and 8,566 OPCABG patients) were included in the systematic review. OPCAGB patients received significantly fewer grafts (2.54 ± 0.16) compared with ONCABG patients (3.22 ± 0.41). Early mortality was comparable at 4.6% and 5.2% in the OPCABG and ONCABG cohorts, respectively (risk ratio [RR], 0.91; 95% CI, 0.64-1.28; p = 0.598). Stroke rates were higher in the ONCABG cohort (RR, 0.65; 95% CI, 0.49- 0.87; p < 0.01). Respiratory failure was higher with ONCABG (RR, 0.74; 95% CI, 0.57-0.97; p = 0.03). New-onset renal failure (p = 0.99), atrial fibrillation (p = 0.27), and myocardial infarction (p = 0.99) were comparable.
  
  
  CONCLUSIONS
  Coronary artery bypass in octogenarians can be performed safely with low early mortality. Although off-pump operations reduce the risk of early stroke, all other adverse events are comparable in on- and off-pump coronary artery bypass operations. Data regarding late mortality is at present limited; however, both on- and off-pump procedures appear to produce comparable survival.
authors: Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan. Electronic address: salah936@yahoo.com.
authors: Salah E
authors: SE
authors: Altarabsheh
authors: Department of Cardiovascular Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors: Salil V
authors: SV
authors: Deo
authors: Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
authors: Abeer M
authors: AM
authors: Rababa'h
authors: Department of Cardiovascular Surgery, Asan Medical Center, Seoul, South Korea.
authors: Ju Yong
authors: JY
authors: Lim
authors: Department of Cardiovascular Surgery, Samsung Hospital, Sungkyunkwan University of Medical Sciences, Seoul, South Korea.
authors: Yang Hyun
authors: YH
authors: Cho
authors: Department of General Surgery, Wellspan York Hospital, York, Pennsylvania.
authors: Vikas
authors: V
authors: Sharma
authors: Department of Cardiovascular Surgery, Asan Medical Center, Seoul, South Korea.
authors: Sung Ho
authors: SH
authors: Jung
authors: Department of Cardiovascular Surgery, Asan Medical Center, Seoul, South Korea.
authors: Euisoo
authors: E
authors: Shin
authors: Department of Cardiovascular Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors: Alan H
authors: AH
authors: Markowitz
authors: Department of Cardiovascular Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors: Soon J
authors: SJ
authors: Park
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control*