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

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. methods and 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; i2=0%. event rates were 0.36% and 1.28% for no-touch and sideclamp opcab,respectively. no difference was seen between pad and side-clamp opcab: 0.71 (0.33-1.55); p=0.39; i2=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. © 2016 the authors.