Clinical outcomes of automated anastomotic devices: A metanalysis

Background and Aims: We investigated neurological events, graft patency, major adverse cardiovascular events (MACEs), and mortality at 1 year following coronary artery bypass grafting (CABG) surgery using automated proximal anastomotic devices (APADs) and compared the overall rates with the current literature. Methods: A systematic review of all available reports of APADs use in the literature was conducted. Cumulative incidence and 95% confidence interval (CI) were the main statistical indexes. Nine observational studies encompassing a total of 718 patients were included at the end of the selection process. Results: The cumulative event rate of neurological complications was 4.8% (lower-upper limits: 2.8-8.0, P <.001; I ² = 72.907%, P =.002; Egger's test: intercept = –2.47, P = 0.16; Begg and Mazumdar test: τ = −0.20, p = 0.57). Graft patency was 90.5% (80.4 to 95.7, P <.001; I ² = 76.823%, P =.005; Egger's test: intercept = –3.04, P =.10; Begg and Mazumdar test: τ = −0.67, P =.17). Furthermore, the overall incidence of MACEs was 3.7% (1.3-10.4, P <.001; I ² = 51.556%, P =.103; Egger's test: intercept = –1.98, P = <.11; Begg and Mazumdar test: τ = −0.67, P =.17). Finally, mortality within 1 year was 5% (3.5-7, P <.001; I ² = 29.675%, P =.202; Egger's test: intercept = –0.91, P =.62; Begg and Mazumdar test: τ = −0.04, P =.88). Conclusions: APADs do not seem to be correlated with a reduction of either neurological events or mortality. By contrast, these tools showed satisfactory one-year graft patency and a low incidence of MACEs. Further research on this topic is warranted.