Neurological outcomes post Coronary Artery Bypass Graft On pump versus off pump- Meta-analysis

Moustafa, Moustafa Gamal El-Din; Hamed, Hosam Mohamed Abd El-Mageed; Abo El-Ala, Osama Abbas Abd El-Hameed; Ibrahim Omar, Mohammed Abdel-Gayed

doi:10.21608/ejsur.2024.309619.1149

Neurological outcomes post Coronary Artery Bypass Graft On pump versus off pump- Meta-analysis

Document Type : Original Article

Authors

Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

10.21608/ejsur.2024.309619.1149

Abstract

Background: Coronary artery disease (CAD) is the primary cause of mortality and a significant public health concern. Numerous treatments exist, such as CABG, which combines two methods: small thoracotomy and sternotomy. Several methods have been devised to enhance the results of surgery, such as using a circulation machine (on-pump) or off-pump.
Objective: To ascertain if neurological results from off-pump and on-pump CABG actually vary in any way.
Patients and Methods: The current study is meta-analysis including randomized controlled trials, retrospective, prospective and observational studies evaluating and comparing neurological outcomes, between on-pump and off-pump on patients undergoing CABG.
Results: The individual odds ratios (OR) favor off-pump CABG, indicating a lower risk of stroke compared to on-pump CABG. It was noted that there were significant differences in the incidence of transient ischemic attacks (TIA) between on-pump and off-pump coronary artery bypass graft (CABG) procedures. Odds ratio (OR) of 0.40 [95% CI: 0.10, 1.62], indicating a lower, though not statistically significant, risk of TIA in the off-pump group. Cognitive impairment. It was reported a slightly lower incidence of cognitive impairment in off-pump patients (0.70%) compared to on-pump patients (0.83%), along with stroke rates of 1.34% for off-pump versus 1.54% for on-pump. It was reported a significant reduction in cognitive impairment for off-pump procedures, with an OR of 0.46 [95% CI: 0.28, 0.77]. The overall pooled OR from the random effects model is 0.51 [95% CI: 0.38, 0.67], suggesting that off-pump CABG is associated with approximately a 49% reduction in the risk of cognitive impairment compared to on-pump CABG.
Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022.
Conclusion: Based on our study result, it was estimated that off-pump CABG associated with a lower incidence of neurological complications than on-pump CABG.

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