Background: Controversies exist whether off-pump coronary artery bypass (OPCAB) is superior to miniaturized extracorporeal circulation (MECC) in reducing deleterious effects of cardiopulmonary bypass as only a number of smaller randomized controlled trials (RCT) currently provide a limited evidence base. The main purpose of conducting the present meta-analysis was to overcome the expected low power in RCTs in an attempt to establish whether MECC is comparable to OPCAB.Methods: A MEDLINE/PubMed search was conducted to identify eligible RCTs. A pooled summary effect estimate was calculated by means of Mantel-Haenszel method.Results: The search yielded 7 RCTs included in this meta-analysis enrolling 271 patients in the OPCAB group and 279 in the MECC group. The OPCAB and MECC groups were comparable in terms of incidence of in-hospital mortality (Risk Difference [RD] 0.01; 95%CI -0.02, 0.03; P = 0.55; I-2 = 0%), stroke (RD -0.01; 95%CI -0.05, 0.04; P = 0.69; I-2 = 0%), need for renal replacement therapy (RD 0.00; -0.06, 0.06; P = 1; I-2 = 0%), postoperative atrial fibrillation (RD -0.03; -0.17, 0.10; P = 0.64; I-2 = 0%), re-exploration for bleeding (RD -0.01; 95%CI -0.03, 0.02; P = 0.65; I-2 = 0%), transfusion rate (RD -0.01; 95%CI -0.03, 0.02; P = 0.65; I-2 = 0%) and the amount of blood loss (weighted mean difference -25 mL; 95%CI -71, 21; P = 0.28; I-2 = 0%).Conclusions: Using a meta-analytic approach, MECC achieves clinical results comparable to OPCAB including postoperative blood loss and blood transfusion requirement. On the basis of our findings, MECC should be considered as a valid alternative to OPCAB in order to reduce surgical morbidity of conventional cardiopulmonary bypass. (C) 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Miniaturized extracorporeal circulation versus off-pump coronary artery bypass grafting: A meta-analysis of randomized controlled trials

Benedetto U.;Vitulli P.;
2015-01-01

Abstract

Background: Controversies exist whether off-pump coronary artery bypass (OPCAB) is superior to miniaturized extracorporeal circulation (MECC) in reducing deleterious effects of cardiopulmonary bypass as only a number of smaller randomized controlled trials (RCT) currently provide a limited evidence base. The main purpose of conducting the present meta-analysis was to overcome the expected low power in RCTs in an attempt to establish whether MECC is comparable to OPCAB.Methods: A MEDLINE/PubMed search was conducted to identify eligible RCTs. A pooled summary effect estimate was calculated by means of Mantel-Haenszel method.Results: The search yielded 7 RCTs included in this meta-analysis enrolling 271 patients in the OPCAB group and 279 in the MECC group. The OPCAB and MECC groups were comparable in terms of incidence of in-hospital mortality (Risk Difference [RD] 0.01; 95%CI -0.02, 0.03; P = 0.55; I-2 = 0%), stroke (RD -0.01; 95%CI -0.05, 0.04; P = 0.69; I-2 = 0%), need for renal replacement therapy (RD 0.00; -0.06, 0.06; P = 1; I-2 = 0%), postoperative atrial fibrillation (RD -0.03; -0.17, 0.10; P = 0.64; I-2 = 0%), re-exploration for bleeding (RD -0.01; 95%CI -0.03, 0.02; P = 0.65; I-2 = 0%), transfusion rate (RD -0.01; 95%CI -0.03, 0.02; P = 0.65; I-2 = 0%) and the amount of blood loss (weighted mean difference -25 mL; 95%CI -71, 21; P = 0.28; I-2 = 0%).Conclusions: Using a meta-analytic approach, MECC achieves clinical results comparable to OPCAB including postoperative blood loss and blood transfusion requirement. On the basis of our findings, MECC should be considered as a valid alternative to OPCAB in order to reduce surgical morbidity of conventional cardiopulmonary bypass. (C) 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11564/805025
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