Abstract 4702: Neurological Complications After Off-pump Coronary Artery Bypass Surgery With and Without Aortic Manipulation: Meta-analysis of 11,398 Cases From 8 Studies
Background: Neurological complications following coronary artery bypass grafting remains to be of concern. Off-pump coronary artery bypass grafting (OPCAB) is one surgical strategy to decrease this risk. Use of an OPCAB “anaortic” technique, which leaves the ascending aorta untouched, may result in further reductions. This systematic review of all published evidence compares neurological complications following “anaortic” OPCAB versus OPCAB with aortic manipulation.
Methods and Results: PubMed and Embase were searched up to August 2008. Experts were contacted and reference lists of retrieved papers where hand searched. The search process was not limited to the English language. Observational studies comparing an OPCAB technique to an OPCAB “anaortic” technique were eligible for inclusion, if they reported neurological complications (stroke and transient ischemic attack). Meta-analysis was conducted to assess differences between groups with regard to neurological complications. The electronic search identified 1,428 abstracts, which resulted in the retrieval and detailed review of 331 full text papers. Eight observational studies reported neurological complications in 5,619 “anaortic” OPCAB patients and 5,779 OPCAB patients with aortic manipulation. Although patients selected for “anaortic” OPCAB tended to have a higher baseline risk of neurological complications, post-surgery neurological complications were significantly lower in these patients (odds ratio, 0.46; 95% confidence intervals, 0.29 to 0.72, I2=0.8%, p=0.0008).
Conclusions: Avoidance of aortic manipulation during OPCAB decreases neurological complications compared to OPCAB where the ascending aorta is manipulated. In patients at high-risk for stroke and/or transient ischemic attack, we recommend avoidance of aortic manipulation during OPCAB.