title: Cerebrovascular Events After No-Touch Off-Pump Coronary Artery Bypass Grafting, Conventional Side-Clamp Off-Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta-Analysis.
abstract: BACKGROUND
  Off-pump coronary artery bypass (OPCAB) has been shown to reduce the risk of neurologic complications as compared to coronary artery bypass grafting performed with cardiopulmonary bypass. Side-clamping of the aorta while constructing proximal anastomoses, however, still carries substantial risk of cerebral embolization. We aimed to perform a comprehensive meta-analysis of studies assessing 2 clampless techniques: aortic "no-touch" and proximal anastomosis devices (PAD) for OPCAB.
  
  
  RESULTS
  PubMed, CINAHL, CENTRAL, and Google Scholar databases were screened for randomized controlled trials and observational studies comparing "no-touch" and/or PAD with side-clamp OPCAB and reporting short-term (≤30 days) outcomes: cerebrovascular accident and all-cause mortality. A total of 18 studies (3 randomized controlled trials) enrolling 25 163 patients were included. Aortic "no-touch" was associated with statistically lower risk of cerebrovascular accident as compared to side-clamp OPCAB: risk ratio 95% CI: 0.41 (0.27-0.61); P<0.01; I(2)=0%. Event rates were 0.36% and 1.28% for "no-touch" and side-clamp OPCAB, respectively. No difference was seen between PAD and side-clamp OPCAB: 0.71 (0.33-1.55); P=0.39; I(2)=39%. A trend towards increased 30-day all-cause mortality with PAD and no difference with "no-touch" were observed when compared to side-clamp OPCAB. In a subset analysis, "no-touch" consistently reduced the risk of cerebrovascular accident regardless of patients' baseline risk characteristics. A benefit with PAD was observed in low-risk patients.
  
  
  CONCLUSIONS
  Aortic "no-touch" technique was associated with nearly 60% lower risk of postoperative cerebrovascular events as compared to conventional side-clamp OPCAB with effect consistent across patients at different risk.
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Pawliszak
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland Division of Ergonomics and Physical Effort, Department of Hygiene, Epidemiology and Ergonomics, Collegium Medicum UMK, Bydgoszcz, Poland kowalewskimariusz@gazeta.pl.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kowalewski
authors.affiliation: Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Raffa
authors.affiliation: Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Malvindi
authors.affiliation: Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland.
authors.forename: Magdalena Ewa
authors.initials: ME
authors.lastname: Kowalkowska
authors.affiliation: Department of Clinical Neuropsychology, Collegium Medicum, Bydgoszcz, Poland Nicolaus Copernicus University, Toruń, Poland.
authors.forename: Krzysztof Aleksander
authors.initials: KA
authors.lastname: Szwed
authors.affiliation: Department of Clinical Neuropsychology, Collegium Medicum, Bydgoszcz, Poland Nicolaus Copernicus University, Toruń, Poland.
authors.forename: Alina
authors.initials: A
authors.lastname: Borkowska
authors.affiliation: Lung Cancer and Thoracic Surgery Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kowalewski
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Anisimowicz
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D016009:Chi-Square Distribution; D003250:Constriction; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: bypass surgery; coronary circulation; meta‐analysis; revascularization