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 2 – Meta-analysis shows the relative risk (RR) of mid-term MACCE rate, mortality and TVR. MACCE: major adverse cardiac and cerebrovascular event, TVR: target vessel revascularization, CI: confidence interval, HCR: hybrid coronary revascularization; OPCAB: off-pump coronary artery bypass grafting. Harskamp 2014 Hu 2010 Kon 2008 Song 2016 Total (95 Cl) Total events Heterogeneity: Chi 2 = 3.99, df = 3 (p = 0.26); I 2 = 25% Test for overall effect: Z = 2.21 (p = 0.03) Total (95 Cl) Total events Heterogeneity: Chi 2 = 4.62, df = 5 (p = 0.46); I 2 = 0% Test for overall effect: Z = 3.02 (p = 0.003) Total events Heterogeneity: Chi 2 = 2.16, df = 2 (p = 0.34); I 2 = 7% Test for overall effect: Z = 1.44 (p = 0.15) 7.1% 31.6% 16.4% 44.9% 100.0% 0.48 [0.05, 5.09] 0.11 [0.01, 0.86] 0.29 [0.04, 2.11] 0.83 [0.38, 1.84] 0.49 [0.26, 0.92] 100.0% 2.20 [1.32, 3.67] Total (95 Cl) 100.0% 0.47 [0.17, 1.32] 0.01 0.1 1 10 100 HCR OPCAB 0.01 0.1 1 10 100 HCR OPCAB 0.01 0.1 1 10 100 HCR OPCAB A. Mid-term MACCE rate B. Mid-term mortality C. Mid-term TVR Harskamp 2014 0.97 [0.06, 14.85] 6.8% Song 2016 0.99 [0.25, 3.88] 27.1% 0.20 [0.03, 1.41] Vassiliades 2009 66.0% Hu 2010 Not estimable Kon 2008 Not estimable Halkos(a) 2011 2.1% 5.81 [0.25, 134.73] Halkos(b) 2011 18.6% 0.33 [0.04, 3.15] Harskamp 2014 44.7% 2.89 [1.45, 5.76] Hu 2010 3.1% 6.00 [0.57, 63.58] Kon 2008 6.3% 1.94 [0.18, 20.35] Song 2016 25.1% 1.65 [0.51, 5.28] Study or Subgroup Weight Risk Ratio Risk Ratio M-H, Fixed, 95% Cl M-H, Fixed, 95% Cl Study or Subgroup Weight Risk Ratio Risk Ratio M-H, Fixed, 95% Cl M-H, Fixed, 95% Cl Study or Subgroup Weight Risk Ratio Risk Ratio M-H, Fixed, 95% Cl M-H, Fixed, 95% Cl and activation of coagulation 26. It has been widely recognized that the dislodgement or rupture of atherosclerotic plaques during surgical aortic manipulation results in a major cause of stroke. 29 Since the aorta is more or less affected in the surgical procedure, it is still unclear whether OPCAB can decrease postoperative stroke rate compared with on-pump CABG. In contrast, grafting in HCR only involves LAD artery while other coronary arteries are treated by PCI. As a result, low rate of neurological complications becomes one of the main advantages of HCR. Although, in the present analysis we detect no significant difference of stroke rate between OPCAB and HCR in a short-term follow-up, which seems to be contradictory to some previous analyses. However, Song et al. 26 reported that more patients in OPCAB group suffer from stroke than HCR group in a 30-month follow-up, which indicates that the differences may be well recognized in a long-term follow-up. In recent years, technical advances inOPCAB utilize a no-touch technique to avoid aortic manipulation during grafting. A retrospective study showed that the OPCAB with no-touch technique could improve prognosis by minimizing the neurological complications and the morbidity. 30 Emmert et al. 31 also reported that the aortic 326