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Side clamp used during off-pump coronary artery bypass does not increase the risk of stroke
Hitoshi Hirose1, Atushi Amano, Akihito Takahashi
1Department of Cardiovascular Surgery, Kobari General Hospital, Chiba, Japan. genex@nifty.com
Insights
Off-pump coronary artery bypass (CABP) resulted in a lower stroke incidence compared to on-pump CABP. Using side clamping for off-pump CABP does not elevate stroke risk.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Technology
Background:
- Coronary artery bypass (CAB) surgery is a critical intervention for coronary artery disease.
- The use of cardiopulmonary bypass (CPB) during CAB has been associated with potential neurological complications, including stroke.
- Off-pump CAB techniques aim to mitigate these risks by avoiding CPB.
Purpose of the Study:
- To compare the incidence of stroke after off-pump versus on-pump coronary artery bypass (CAB).
- To identify risk factors associated with postoperative stroke in CAB patients.
- To evaluate the safety of side clamping the ascending aorta in off-pump CAB procedures.
Main Methods:
- A prospective study involving patients undergoing isolated coronary artery bypass (CAB) between 1996 and 2001.
- Patients were categorized into on-pump and off-pump groups based on the use of cardiopulmonary bypass.
- Perioperative data were collected to analyze stroke risk factors.
Main Results:
- The incidence of postoperative stroke was significantly lower in the off-pump group (0.3%) compared to the on-pump group (2.0%).
- Key predictors of stroke included the use of cardiopulmonary bypass, age over 75, and peripheral vascular disease.
- While preoperative comorbidities were higher in the off-pump group, stroke rates were still lower.
Conclusions:
- Off-pump coronary artery bypass (CAB) is associated with a reduced incidence of postoperative stroke compared to on-pump CAB.
- The use of side clamping for aortocoronary bypass in off-pump procedures does not appear to increase the risk of stroke.
- These findings support off-pump CAB as a potentially safer alternative regarding neurological outcomes.
Background:
The purpose of this study was to investigate whether the incidence of stroke after off-pump AC bypass was lower than that after on-pump AC bypass.
Material/Methods:
A prospective study was performed with consecutive patients who underwent isolated AC bypass in the Shin-Tokyo Hospital Group between July 1, 1996 and December 31, 2001 AC bypass was defined as coronary artery bypass requiring proximal anastomoses onto the ascending aorta. The patients were divided into two groups, depending on the use of cardiopulmonary bypass: on-pump and off-pump groups. Perioperative data were prospectively collected and the risk factors for postoperative stroke were investigated.
Results:
Preoperative comorbidities were more frequent in the off-pump group. The number of distal anastomoses was not significantly different but the number of proximal anastomoses was significantly greater in the on-pump group than in the off-pump group. The incidence of postoperative stroke was 0.3% in the off-pump group and 2.0% in the on-pump group. Significant risk factors influencing the occurrence of postoperative stroke included: use of cardiopulmonary bypass, age over 75, peripheral vascular disease, saphenous vein use, and postoperative atrial fibrillation. Multivariate analysis demonstrated that the use of cardiopulmonary bypass, age over 75, and peripheral vascular disease were isolated predictors of postoperative stroke.
Conclusions:
The incidence of postoperative stroke was lower in the off-pump group than in the on-pump group, even though the side clamp was applied to the ascending aorta for aortocoronary bypass. The use of side clamping for off-pump AC bypass does not increase the risk of postoperative stroke.