Off-pump coronary artery bypass surgery may reduce the incidence of stroke in patients with significant left main stem disease.

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.