Cirugía coronaria sin bomba: revisión sistemática contemporánea y metaanálisis de sus resultados respecto a la cirugía con circulación extracorpórea

Abstract

Introduction and objectivesAfter 30 years, off-pump coronary artery bypass grafting benefits are still controversial when compared with the on-pump technique. For this reason, a meta-analysis is presented that compares the early and long-term results of the 2surgical strategies. MethodsA search was made of PubMed, EMBASE, and the Cochrane library database for clinical trials up to December 2017 for randomised clinical trials investigating off-pump versus on-pump coronary surgery with sample size of ≥ 100 patients. ResultsA total of 34 clinical trials, with a total of 16,435 patients and 9643 examined grafts were included in this meta-analysis. Off-pump surgery achieved similar 30-day and 1-year mortality compared with on-pump surgery. The off-pump technique significantly decreased the risk of 30-day stroke (RR 0.73; 95% CI; 0.57-0.94; p=0.015), but it increases 1-year repeat revascularization risk (RR 1.52; 95% CI; 1.18-1.96; p=0.001), 5-year mortality risk (RR= 1.15; 95% CI; 1.03-1.29; p=0.012) and it is associated with worse graft patency (RR 0.97; 95% CI; 0.94-0.99; p=0.007) compared with on-pump surgery. ConclusionsOff-pump coronary surgery may provide better short-term neurological results compared with the on-pump technique, at the expense of a worse graft patency, increased risk of 1-year repeat revascularisation, and of 5-years mortality.