Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta – A Meta-Analysis

BackgroundThe 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.MethodWe performed a meta-analysis of seven studies comparing coronary artery bypass grafting (CABG) with and without manipulation of the ascending aorta.ResultsWhen 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).ConclusionAvoiding aortic manipulation during CABG may decrease the rate of peri-operative stroke.