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Thorac Cardiovasc Surg 2008; 56(5): 247-255
DOI: 10.1055/s-2008-1038514
Review

© Georg Thieme Verlag KG Stuttgart · New York

Off-Pump Coronary Artery Bypass Surgery May Reduce the Incidence of Stroke in Patients with Significant Left Main Stem Disease

S. S. Panesar1 , J. Chikwe2 , S. B. Mirza2 , M. S. Rahman2 , O. Warren2 , C. Rao2 , J. Negus2 , E. Zacharakis2 , A. Darzi2 , T. Athanasiou2
  • 1Department of Biosurgery and Surgical Technology, Imperial College London, London, United Kingdom
  • 2Imperial College London, London, United Kingdom
Further Information

Publication History

received July 26, 2007

Publication Date:
09 July 2008 (online)

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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.

Key words

cardiovascular surgery - coronary bypass surgery - myocardial protection

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Dr. MBBS Sukhmeet Singh Panesar

Department of Biosurgery and Surgical Technology
Imperial College London

10th Floor, QEQM Building, St. Mary's Hospital, Praed Street

W2 1NY London

United Kingdom

Phone: + 44 20 73 85 55 84

Fax: + 44 20 78 86 18 10

Email: sukhmeet.panesar@imperial.ac.uk

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