Off-versus on-pump coronary surgery and the effect of follow-up length and surgeons’ experience: A meta-analysis

Mario Gaudino, Umberto Benedetto, Faisal Bakaeen, Mohamed Rahouma, Derrick Y. Tam, Ahmed Abouarab, Antonino Di Franco, Jeremy Leonard, Adham Elmously, John D. Puskas, Gianni D. Angelini, Leonard N. Girardi, Stephen E. Fremes, David P. Taggart

Research output: Contribution to journalReview articlepeer-review

55 Scopus citations


Background-The debate on the relative benefits of off-pump and on-pump coronary artery bypass surgery (OPCABG and ONCABG) is still open. We aimed to provide an updated and complete summary of the evidence on the differences between OPCABG and ONCABG and to explore whether the length of the follow-up and the surgeons’ experience in OPCABG modify the comparative results. Methods and Results-All randomized clinical trials comparing OPCABG and ONCABG were included. Primary outcome was followup mortality. Secondary outcomes were operative mortality, perioperative stroke, perioperative myocardial infarction, and late repeated revascularization. Subgroup analyses were performed based on the length of the follow-up and the percentage of crossover from the OPCABG group (used as a surrogate of surgeon experience with OPCABG). One hundred four trials were included (20 627 patients, OPCABG: 10 288; ONCABG: 10 339). Weighted mean follow-up time was 3.7 years (range 1-7.5 years). OPCABG was associated with a higher risk of follow-up mortality (incidence rate ratio 1.11, 95% confidence interval 1.00-1.23, P=0.05). The difference was significant only for trials with mean follow-up of ≥3 years and for studies with a crossover rate of ≥10%. There was a trend toward lower risk of perioperative stroke and higher need for late repeated revascularization in the OPCABG arm. Conclusions-OPCABG is associated with a higher incidence of incomplete revascularization, an increased need for repeated revascularization, and decreased midterm survival compared with ONCABG. Surgeon inexperience in OPCABG is associated with late mortality.

Original languageEnglish
Article numbere010034
JournalJournal of the American Heart Association
Issue number21
StatePublished - 1 Nov 2018


  • Coronary artery bypass
  • Coronary artery bypass grafting
  • Myocardial revascularization
  • Off-pump coronary artery bypass grafting
  • Off-pump surgery
  • Revascularization


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