title: Off-pump coronary artery bypass surgery may reduce the incidence of stroke in patients with significant left main stem disease.
abstract: BACKGROUND
  Off-pump coronary artery bypass (OPCAB) surgery in patients with left main stem (LMS) disease remains controversial. This meta-analysis compares early outcomes of OPCAB surgery with on-pump coronary artery bypass (ONCAB) surgery in patients with significant LMS disease, focusing on the outcomes stroke and transient ischemic attack (TIA).
  
  
  METHODS
  This is a meta-analysis of non-randomized comparative peer-reviewed publications sourced from a systematic search of Embase, Medline, Cochrane, Google Scholar and CINAHL (1965-2007). A random effects model was used and heterogeneity was assessed.
  
  
  RESULTS
  Nine studies (4411 patients) dating from 2000-2007, of whom 1036 (23.5 %) underwent OPCAB and 3375 (76.5 %) ONCAB, were included. The incidence of stroke was lower in the OPCAB group (OR 0.17 [95 % CI 0.05 to 0.60]). Early mortality, length of hospital stay, blood loss and inotropic requirements were significantly favored by OPCAB surgery.
  
  
  CONCLUSIONS
  OPCAB may offer a neurological benefit in patients with significant LMS disease undergoing coronary artery bypass grafting.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, United Kingdom. sukhmeet.panesar@imperial.ac.uk
authors.forename: S S
authors.initials: SS
authors.lastname: Panesar
authors.forename: J
authors.initials: J
authors.lastname: Chikwe
authors.forename: S B
authors.initials: SB
authors.lastname: Mirza
authors.forename: M S
authors.initials: MS
authors.lastname: Rahman
authors.forename: O
authors.initials: O
authors.lastname: Warren
authors.forename: C
authors.initials: C
authors.lastname: Rao
authors.forename: J
authors.initials: J
authors.lastname: Negus
authors.forename: E
authors.initials: E
authors.lastname: Zacharakis
authors.forename: A
authors.initials: A
authors.lastname: Darzi
authors.forename: T
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D016063:Blood Loss, Surgical; D002316:Cardiotonic Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control*; D007902:Length of Stay; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents