title: On- vs. off-pump coronary artery bypass grafting: A systematic review and meta-analysis.
abstract: BACKGROUND
  To reduce complications during coronary artery bypass grafting (CABG) off-pump CABG was introduced; however, results have been mixed. The aim of this work was to conduct a systematic review and meta-analysis of off-pump vs. on-pump CABG.
  
  
  METHODS
  To identify potential studies systematic searches were carried out using various databases. The search strategy included the key concepts of "cardiopulmonary bypass" AND "coronary artery bypass grafting" AND "off pump". This was followed by a meta-analysis investigating post-operative atrial fibrillation, myocardial infarction, ≤30day mortality, stroke, ventilation time, intensive care unit (ICU) stay and hospital stay.
  
  
  RESULTS
  Fifty four studies (59 intervention groups), totalling 16,261 participants were analysed. Off pump CABG led to a significantly lower incidence of post-operative atrial fibrillation odds ratio (OR) 0.87 (95% confidence interval [CI] 0.78 to 0.97, p=0.01), but no differences in either myocardial infarction OR 0.98 (95% CI 0.82 to 1.15, p=0.77) or ≤30day mortality OR 0.85 (95% CI 0.68 to 1.06, p=0.16). There was a strong trend towards a reduced incidence of stroke OR 0.77 (95% CI 0.59 to 1.00, p=0.05); however this did not quite reach significance. Ventilation time mean difference (MD) -3.78h (95% CI -4.75 to -2.82, p<0.00001); ICU stay MD -0.34days (95% CI -0.50 to -0.17, p<0.0001); and hospital stay MD -0.9days (95% CI -1.25 to -0.56, p<0.00001) were all significantly shorter in the off-pump group.
  
  
  CONCLUSIONS
  Off-pump CABG has some benefits over on-pump CABG, particularly in relation to post-operative atrial fibrillation.
authors.affiliation: School of Science and Technology, University of New England, Armidale, NSW 2350, Australia.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Dieberg
authors.affiliation: School of Science and Technology, University of New England, Armidale, NSW 2350, Australia.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Smart
authors.affiliation: School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth PL4 8AA, UK. Electronic address: nicola.king@plymouth.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: King
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology*
keywords: Coronary artery bypass graft; Hospital costs; Off-pump; On-pump; Stroke