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Alsharif A, Alsharif A, Alshamrani G, Abu Alsoud A, Abdullah R, Aljohani S, Alahmadi H, Fuadah S, Mohammed A, Hassan FE. Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review. Clin Pract 2024; 14:1842-1868. [PMID: 39311297 PMCID: PMC11417699 DOI: 10.3390/clinpract14050147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 08/31/2024] [Accepted: 09/05/2024] [Indexed: 09/26/2024] Open
Abstract
Coronary artery bypass grafting (CABG) is an essential operation for patients who have severe coronary artery disease (CAD). Both open and minimally invasive CABG methods are used to treat CAD. This in-depth review looks at the latest research on the effectiveness of open versus minimally invasive CABG. The goal is to develop evidence-based guidelines that will improve surgical outcomes. This systematic review used databases such as PubMed, MEDLINE, and Web of Science for a full electronic search. We adhered to the PRISMA guidelines and registered the results in the PROSPERO. The search method used MeSH phrases and many different study types to find papers. After removing duplicate publications and conducting a screening process, we collaboratively evaluated the full texts to determine their inclusion. We then extracted data, including diagnosis, the total number of patients in the study, clinical recommendations from the studies, surgical complications, angina recurrence, hospital stay duration, and mortality rates. Many studies that investigate open and minimally invasive CABG methods have shown that the type of surgery can have a large effect on how well the patient recovers and how well the surgery works overall. While there are limited data on the possible advantages of minimally invasive CABG, a conclusive comparison with open CABG is still dubious. Additional clinical trials are required to examine a wider spectrum of patient results.
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Affiliation(s)
- Arwa Alsharif
- Department of Medicine and Surgery, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (G.A.); (A.A.A.); (R.A.); (S.A.); (S.F.); (A.M.)
| | - Abdulaziz Alsharif
- Department of Medicine and Surgery, Vision College, Jeddah 23643, Saudi Arabia;
| | - Ghadah Alshamrani
- Department of Medicine and Surgery, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (G.A.); (A.A.A.); (R.A.); (S.A.); (S.F.); (A.M.)
| | - Abdulhameed Abu Alsoud
- Department of Medicine and Surgery, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (G.A.); (A.A.A.); (R.A.); (S.A.); (S.F.); (A.M.)
| | - Rowaida Abdullah
- Department of Medicine and Surgery, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (G.A.); (A.A.A.); (R.A.); (S.A.); (S.F.); (A.M.)
| | - Sarah Aljohani
- Department of Medicine and Surgery, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (G.A.); (A.A.A.); (R.A.); (S.A.); (S.F.); (A.M.)
| | - Hawazen Alahmadi
- Faculty of Medicine, Taibah University, Al-Madinah Almunawwarah 41477, Saudi Arabia;
| | - Samratul Fuadah
- Department of Medicine and Surgery, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (G.A.); (A.A.A.); (R.A.); (S.A.); (S.F.); (A.M.)
| | - Atheer Mohammed
- Department of Medicine and Surgery, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (G.A.); (A.A.A.); (R.A.); (S.A.); (S.F.); (A.M.)
| | - Fatma E. Hassan
- Medical Physiology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Giza 11562, Egypt;
- General Medicine Practice Program, Department of Physiology, Batterjee Medical College, Jeddah 21442, Saudi Arabia
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Sajja LR. Six decades of cardiothoracic surgery: navigating new horizons, mending hearts with science and precision. Indian J Thorac Cardiovasc Surg 2024; 40:280-291. [PMID: 38681701 PMCID: PMC11045708 DOI: 10.1007/s12055-024-01719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, Telangana India 500034
- Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Hyderabad, India 500073
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Sajja LR, Sarkar K, Mannam G, Padmanabhan C, Narayan P, Kamtam DN, Balakrishna N, Kodali VKK, Mulay A, Peter S, Beri P. Five-year outcomes of off and on-pump CABG: Insights from PROMOTE Patency Trial. Asian Cardiovasc Thorac Ann 2023; 31:659-666. [PMID: 37624649 DOI: 10.1177/02184923231197642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND There are limited studies reporting follow-up outcome data comparing of off-pump coronary artery bypass (OPCAB) with on-pump (ONCAB) technique. The aim of the study was to report the 5-year clinical outcomes of OPCAB and ONCAB in a post hoc analysis of the PROMOTE patency trial. METHODS From March 2016 through March 2017, a total of 321 patients undergoing coronary artery bypass grafting (CABG) were randomised to either the off-pump or the on-pump technique. Data on all-cause mortality, myocardial infarction (MI), cerebrovascular accident (CVA), repeat revascularisation and need for renal replacement therapy (RRT) were recorded. The composite and each of these individual outcomes are reported at 5-year interval. RESULTS The mean follow-up period was 65.9 months (±3.39). A total of 275 (85.93%) patients followed up at the 5-year interval who underwent CABG by the off-pump (n = 158) and the on-pump (n = 162) technique. The all-cause mortality was 8.9% and 5.7% in ONCAB and OPCAB, respectively (hazard ratio [HR] = 0.62; 95% confidence interval [CI] 0.25-1.57, p = 0.31). The composite of all-cause mortality, non-fatal MI, non-fatal CVA, RRT and need for repeat revascularisation was comparable in both groups (7.1% vs. 11.9%, HR = 0.57; 95% CI 0.25-1.31, p = 0.18 in OPCAB and ONCAB, respectively). The rates of 5-year non-fatal MI (p = 0.2), non-fatal CVA (p = 0.36) and need for repeat revascularisation (p = 1) were similar in both groups. A sub-group analysis did not show any significant interaction or effect modification with either of the techniques. CONCLUSIONS The 5-year clinical outcomes of OPCAB are comparable to ONCAB in low-risk patients undergoing CABG. Off-pump coronary artery bypass had no additional benefit in any subgroup.
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Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Hyderabad, India
- Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Hyderabad, India
| | - Kunal Sarkar
- Division of Cardiothoracic Surgery, Medica Superspeciality Hospital, Kolkata, India
| | - Gopichand Mannam
- Division of Cardiothoracic Surgery, Star Hospitals, Hyderabad, India
| | | | - Pradeep Narayan
- Division of Cardiothoracic Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Devanish Nh Kamtam
- Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Hyderabad, India
| | | | | | - Anvay Mulay
- Division of Cardiothoracic Surgery, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Sanjeeth Peter
- Division of Cardiothoracic Surgery, DDMM Heart Institute, Nadiad, India
| | - Prashanthi Beri
- Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Hyderabad, India
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Zhou Z, Fu G, Feng K, Huang S, Chen G, Liang M, Wu Z. Randomized evidence on graft patency after off-pump versus on-pump coronary artery bypass grafting: An updated meta-analysis. Int J Surg 2022; 98:106212. [PMID: 35041977 DOI: 10.1016/j.ijsu.2021.106212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The debate between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) has been ongoing for decades. We aimed to provide a comprehensive update of the current randomized controlled trials (RCTs) in evaluating the graft patency of OPCAB versus ONCAB. MATERIALS AND METHODS A literature search was conducted in PubMed, EMBASE, and the Cochrane Library databases until April 30, 2021. All RCTs from 2003 to 2020 comparing the results of graft patency between OPCAB and ONCAB were included. We compared the overall graft occlusion between the two groups, and subgroup analyses were conducted based on different types of conduits and target territories, crossover from off-pump to on-pump rate, and the length of follow-up. RESULTS Sixteen RCTs were identified, with 5743 grafts in the OPCAB group and 5898 in the ONCAB group. OPCAB was associated with a higher risk of occlusion in the overall graft (RR: 1.31; 95% CI, 1.17-1.46), saphenous vein graft (SVG) (RR: 1.40; 95% CI, 1.23-1.59), grafts to left anterior descending (LAD) territory (RR: 1.52; 95% CI, 1.11-2.08) and left circumflex artery (LCX) territory (RR: 1.45; 95% CI, 1.19-1.76), while no significant difference was observed between the two groups in respect of arterial conduits and grafts to right coronary artery (RCA) territory. Furthermore, the lower crossover rate and longer length of follow-up appeared to reduce the association between OPCAB and lower graft patency. CONCLUSIONS The current meta-analysis indicates that, compared with ONCAB, graft patency is poorer with OPCAB for overall grafts, SVG grafts, grafts to LAD and LCX territories, whereas the results remain comparable for arterial conduits and grafts to RCA territory.
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Affiliation(s)
- Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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Sajja LR, Sarkar K, Mannam G, Kodali VKK, Padmanabhan C, Peter S, Mulay A, Sardar S, Beri P. One-year outcomes of off- and on-pump coronary artery bypass grafting: PROMOTE patency trial. Indian J Thorac Cardiovasc Surg 2020; 36:469-475. [PMID: 33061158 PMCID: PMC7525622 DOI: 10.1007/s12055-020-00940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Earlier we reported 3-month graft patency and clinical outcomes of prospective randomized comparison of off-pump and on-pump multivessel coronary artery bypass surgery to evaluate outcomes and graft patency (PROMOTE patency) trial. We now report major adverse cardiac and cerebrovascular events (MACCE) at 1 year of patients who underwent coronary artery bypass grafting (CABG) using either off-pump technique or on-pump technique. METHODS The PROMOTE patency trial is a two-arm, prospective, randomized, multicentre trial, and enrolled 320 patients with multivessel coronary artery disease from March 2016 through March 2017 at 6 centres and were randomly assigned to undergo either off-pump CABG (OPCAB) (n = 158 patients) or on-pump CABG (n = 162 patients). The outcomes at 1 year were assessed. RESULTS One mortality (0.64%) occurred in off-pump group (at 30 days) and 4 (2.48%) in on-pump group (1 at 30 days, 2 at 3 months, and 1 at 1 year) (p = 0.37). There was no difference between off-pump and on-pump groups in the outcomes of nonfatal myocardial infarction (1 in off-pump and 2 in on-pump group, p = 1.00) and cerebrovascular accident (none in off-pump and 2 in on-pump group, p = 0.49). Repeat revascularization was done in one patient in each group (p = 1.00). CONCLUSION There was no significant difference in the incidence of MACCE between off-pump and on-pump CABG group at 1 year.
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Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Road no. 10, Banjara Hills, Hyderabad, AP 500 034 India
- Division of Cardiothoracic Surgery, Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500 073 India
| | - Kunal Sarkar
- Division of Cardiothoracic Surgery, Medica Superspeciality Hospital, 127-Mukundapur, EM Bypass, Kolkata, 700025 India
| | - Gopichand Mannam
- Division of Cardiothoracic Surgery, Star Hospitals, Road no. 10, Banjara Hills, Hyderabad, AP 500 034 India
| | - Venkata Krishna Kumar Kodali
- Division of Cardiothoracic Surgery, Krishna Institute of Medical Sciences, 1-8-31/1, Minister Road, Secunderabad, Telangana 500003 India
| | - Chandrasekar Padmanabhan
- Division of Cardiothoracic Surgery, G Kuppuswamy Naidu Memorial Hospital, Pappanaickenpalayam, Coimbatore, 641 037 India
| | - Sanjeeth Peter
- Division of Cardiothoracic Surgery, DDMM Heart Institute, Mission Road, Nadiad, Gujarat 387 002 India
| | - Anvay Mulay
- Division of Cardiothoracic Surgery, Fortis Hospital, Multi-Specialty Hospital Mulund West, Mumbai, 400 078 India
| | - Sandip Sardar
- Division of Cardiothoracic Surgery, Medica Superspeciality Hospital, 127-Mukundapur, EM Bypass, Kolkata, 700025 India
| | - Prashanthi Beri
- Division of Clinical Research, Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500 073 India
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Narayan P. Off-pump versus on-pump bypass surgery for left main coronary artery disease (EXCEL study) - is experience the unknown variable? Indian J Thorac Cardiovasc Surg 2020; 36:253-255. [PMID: 33061136 PMCID: PMC7525569 DOI: 10.1007/s12055-019-00914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022] Open
Abstract
A post hoc analysis of the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) data compared off-pump coronary artery bypass (OPCAB) technique with conventional coronary artery bypass grafting (CABG). It was reported that OPCAB was associated with lower rate of revascularization especially in the inferolateral wall and carried increased risk of 3-year all-cause mortality compared to on-pump CABG. However, the study does not provide any information on the experience of participating surgeons which is a key determinant of outcomes in OPCAB surgery. In the absence of this key variable, the extrapolation and applicability of this finding to the wider surgical practice, especially in countries like India and Japan, may not be accurate.
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Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
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Narayan P. PROMOTE patency-does it have the answers? Indian J Thorac Cardiovasc Surg 2020; 36:91-92. [PMID: 33061106 PMCID: PMC7528419 DOI: 10.1007/s12055-019-00881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/05/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, 700099 India
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