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Improving neurologic outcome in off-pump surgery: the "no touch" technique
Marzia Leacche1, Michel Carrier, Denis Bouchard
1Department of Cardiac Surgery and Research Center, Montreal Heart Institute, Montreal, Quebec, Canada. rc2910@aol.com
The Heart Surgery Forum
|June 25, 2003
Summary
The "no touch" technique (NTT) for coronary artery bypass grafting (CABG) is safe for high-risk patients with aortic and carotid disease. This approach avoids aortic manipulation, potentially reducing stroke and improving early outcomes in older, complex surgical candidates.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Anesthesia
Background:
- Increasingly older patients undergoing cardiac surgery present with complex comorbidities like cerebrovascular disease, carotid disease, and aortic atherosclerosis.
- Minimizing ascending aorta manipulation during coronary artery bypass grafting (CABG) may be crucial for patient safety in this high-risk population.
Purpose of the Study:
- To evaluate the safety and efficacy of the "no touch" technique (NTT) in off-pump CABG, specifically in patients with severe aortic and carotid disease.
- To assess the impact of avoiding aortic manipulation on perioperative outcomes and early results.
Main Methods:
- Retrospective review of 640 off-pump CABG patients, identifying 84 who underwent the NTT.
- Revascularization utilized internal thoracic arteries (ITAs) and additional grafts (saphenous vein, radial artery) in T or Y configurations.
- Brachiocephalic artery was used as an alternative inflow site in reoperation cases.
Main Results:
- The NTT group had higher frequencies of severe aortic atherosclerosis (13% vs. 0%), carotid disease (25% vs. 16%), and prior cerebrovascular accidents (17% vs. 8%).
- Complete revascularization rates were comparable (96% off-pump CABG vs. 90% NTT).
- No significant differences in low cardiac output syndrome, intra-aortic balloon pump use, perioperative myocardial infarction, or 30-day mortality were observed. The NTT group showed trends toward lower delirium, stroke, and shorter ICU and hospital stays.
Conclusions:
- Avoiding aortic manipulation via NTT is technically feasible in patients with severe atherosclerosis, carotid disease, and cerebrovascular history.
- This technique is associated with low mortality and favorable short-term outcomes.
- Adopting NTT may decrease stroke incidence and enhance early outcomes in selected high-risk patients.