Coronary artery bypass grafting with and without manipulation of the ascending aorta--a meta-analysis
J James Edelman1, Tristan D Yan, Paul G Bannon
1Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. jjbedelman@gmail.com
Insights
Avoiding aortic manipulation during coronary artery bypass grafting (CABG) significantly reduces stroke risk. Anaortic off-pump CABG shows a lower stroke rate compared to conventional CABG and other off-pump techniques.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Interventional Cardiology
Background:
- The SYNTAX trial highlighted an increased stroke rate with coronary artery bypass grafting (CABG) versus percutaneous coronary intervention.
- Aortic manipulation during CABG is a potential contributor to peri-operative stroke.
Purpose of the Study:
- To evaluate the impact of avoiding aortic manipulation on stroke rates during CABG.
- To compare stroke incidence between anaortic off-pump CABG and conventional CABG.
Main Methods:
- A meta-analysis was conducted on seven studies.
- Studies compared coronary artery bypass grafting (CABG) with and without manipulation of the ascending aorta.
Main Results:
- Anaortic off-pump CABG demonstrated a stroke rate of 0.38% compared to 1.87% for conventional CABG (p<0.0001).
- Anaortic off-pump CABG showed a 0.31% stroke rate versus 1.35% for off-pump CABG with aortic clamping (p=0.003).
Conclusions:
- Avoiding aortic manipulation during CABG appears to significantly decrease the incidence of peri-operative stroke.
- Anaortic off-pump CABG is associated with a lower risk of stroke compared to conventional CABG.
Background:
The main criticism of surgery in the SYNTAX trial was increased rate of stroke when compared to percutaneous coronary intervention. We aimed to determine whether avoiding aortic manipulation would decrease the rate of stroke.
Method:
We performed a meta-analysis of seven studies comparing coronary artery bypass grafting (CABG) with and without manipulation of the ascending aorta.
Results:
When anaortic off-pump coronary artery bypass grafting (OPCAB) was compared with conventional CABG, the rate of stroke was 0.38% vs. 1.87% (p<0.0001). When anaortic OPCAB was compared with OPCAB using a side-clamp or proximal graft anastomosis device the rate of stroke was 0.31% vs. 1.35% (p=0.003).
Conclusion:
Avoiding aortic manipulation during CABG may decrease the rate of peri-operative stroke.
