Department of Cardiac Surgery, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany.
J Thorac Cardiovasc Surg. 2011 Aug;142(2):e11-7. doi: 10.1016/j.jtcvs.2010.11.034. Epub 2011 Feb 1.
Neurologic complications after coronary artery bypass grafting remain a concern. Off-pump coronary artery bypass grafting is a surgical strategy proposed to decrease this risk. Use of an off-pump anaortic technique, which leaves the ascending aorta untouched, may result in further reductions. This systematic review of all published evidence compares neurologic complications after anaortic off-pump coronary artery bypass grafting versus that with aortic manipulation.
PubMed and Embase were searched up to August 2008. Experts were contacted, and reference lists of retrieved articles were hand searched. The search process was not limited to English-language sources. Observational studies comparing standard off-pump coronary artery bypass grafting technique with anaortic technique were eligible for inclusion if they reported neurologic complications (stroke and transient ischemic attack). Meta-analysis was conducted to assess differences between groups with regard to neurologic complications.
Electronic search identified 1428 abstracts, which resulted in retrieval and detailed review of 331 full-text articles. Eight observational studies reported neurologic complications in 5619 anaortic off-pump coronary artery bypass grafting cases and 5779 cases with aortic manipulation. Postsurgical neurologic complications were significantly lower in anaortic off-pump coronary artery bypass grafting cases (odds ratio, 0.46; 95% confidence interval, 0.29-0.72; I(2) = 0.8%; P = .0008).
Avoidance of aortic manipulation during off-pump coronary artery bypass grafting decreases neurologic complications relative to standard technique in which the ascending aorta is manipulated. In patients at high risk for stroke or transient ischemic attack, we recommend avoidance of aortic manipulation during off-pump coronary artery bypass grafting.
冠状动脉旁路移植术后的神经系统并发症仍然令人关注。非体外循环冠状动脉旁路移植术是一种旨在降低这种风险的外科策略。使用不接触升主动脉的非体外循环无主动脉操作技术可能会进一步降低风险。本系统评价对所有已发表的证据进行了比较，比较了非体外循环无升主动脉操作与主动脉操作的冠状动脉旁路移植术后神经系统并发症。
检索了 PubMed 和 Embase 截至 2008 年 8 月的资料。联系了专家，并对检索到的文章的参考文献进行了手工检索。检索过程不限于英语来源。如果报道了神经系统并发症（中风和短暂性脑缺血发作），则符合纳入标准的是比较标准非体外循环冠状动脉旁路移植术与非体外循环无升主动脉操作技术的观察性研究。采用荟萃分析评估两组神经系统并发症的差异。
电子检索确定了 1428 篇摘要，其中检索并详细评价了 331 篇全文文章。8 项观察性研究报告了 5619 例非体外循环无升主动脉操作冠状动脉旁路移植术和 5779 例主动脉操作病例的神经系统并发症。非体外循环无升主动脉操作冠状动脉旁路移植术的术后神经系统并发症明显较低（比值比，0.46；95%置信区间，0.29-0.72；I(2) = 0.8%；P = 0.0008）。
与主动脉操作的标准技术相比，在非体外循环冠状动脉旁路移植术中避免主动脉操作可降低神经系统并发症的发生率。在中风或短暂性脑缺血发作风险较高的患者中，我们建议避免在非体外循环冠状动脉旁路移植术中进行主动脉操作。
