ABC | Volume 110, Nº4, April 2018

Original Article Dong et al Comparison between HCR and OPCAB Arq Bras Cardiol. 2018; 110(4):321-330 Figure 1 – Flow diagram shows the process of literature selection. Literatures were searched in Pubmed, EMBASE, Web of Science and Cochrane databases. Articles identified from databases above: 1045 Potentially eligible full-text articles after screening: 52 Articles included in the meta-analysis: 9 Case report: 2 Review or meta-analysis: 14 Letter or comment: 5 Conference abstract: 1 Others did not meet the inclusion criteria: 21 Duplicated papers: 399 Non-English: 124 Irrelavant papers: 470 for heterogeneity = 0.85, I 2 = 0%) or mortality (RR: 0.51, 95% CI: 0.17–1.48, p = 0.22; p for heterogeneity = 0.99, I 2  = 0%) or stroke (RR: 0.93, 95% CI: 0.28–3.05, p = 0.90; p for heterogeneity = 1.00, I 2 = 0%) between the two groups. HCR required less ventilator time (standardized mean difference (SMD): -0.36, 95% CI: -0.55– -0.16, p < 0.001), ICU stay (SMD: -0.35, 95% CI: -0.58– -0.13, p < 0.01), hospital stay (SMD: -0.29, 95% CI: -0.50– -0.07, p < 0.05) and blood transfusion rate (relative risk (RR): 0.57, 95% CI: 0.49–0.67, p < 0.001), but needed more operation time (SMD: 1.29, 95% CI: 0.54–2.05, p < 0.001) and hospitalization costs (SMD: 1.06, 95% CI: 0.45–1.66, p < 0.001). Subgroup analysis Table 3 also showed the subgroup analysis, which was performed by dividing the studies into staged-HCR group and simultaneous-HCR group. No statistical difference was observed in short-term MACCE rate or mortality in the two subgroups (p value in both subgroups > 0.05). Mid-term outcomes The studies that contained mid-term outcomes were included in the analysis. As shown in Figure 2, the HCR group had lower MACCE rate (RR: 0.49, 95% CI: 0.26–0.92, p < 0.05, P for heterogeneity = 0.26, I 2 = 25%) but had higher rate in TVR (RR: 2.20, 95% CI: 1.32–3.67, p < 0.01, P for heterogeneity = 0.46, I 2 = 0%) in mid-term follow. No significant difference in mid-term mortality was detected between the two groups (RR: 0.47, 95% CI: 0.17–1.32, p < 0.01, P for heterogeneity = 0.34, I 2 = 7%). Heterogeneity In the current analysis, no obvious heterogeneity was found between studies in either short-term or mid-term MACCE rate and mortality (p for heterogeneity > 0.05, I 2  < 50%). And subgroup analysis showed no heterogeneity (p for heterogeneity = 0.95, I 2 = 0%). Publication bias The funnel graph of short-termMACCE rate was established in Figure 3, and there was no evident publication bias among all included studies by visual examination. Discussion The present meta-analysis shows that HCR, compared with OPCAB, seems not to significantly improve short-termmortality and morbidity of postoperative complications for patients with CAD. These results are similar to previews research. Hu 27 first systematically compared the short-term clinical outcomes after HCR versus OPCAB for the treatment of multivessel or left main CAD, and most of the results were consistent with the current analysis. However, some differences between the two analyses should be also mentioned. We excluded one study 28 due to small sample size(less than 15 patients), outdated 323