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No-touch aorta off-pump coronary surgery: the effect on stroke
Oren Lev-Ran1, Rony Braunstein, Ram Sharony
1Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. orenlevran@hotmail.com <orenlevran@hotmail.com>
The Journal of Thoracic and Cardiovascular Surgery
|January 29, 2005
Summary
Avoiding aortic manipulation during off-pump coronary artery bypass grafting significantly reduces stroke risk. The no-touch technique offers superior neurologic outcomes, regardless of aortic disease severity, and is recommended when feasible.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Off-pump coronary artery bypass grafting (OPCAB) aims to reduce neurologic complications.
- Previous studies on OPCAB neuroprotection yielded inconsistent results.
- Techniques differ in aortic manipulation, impacting outcomes.
Purpose of the Study:
- To evaluate the impact of avoiding aortic manipulation on neurologic outcomes in OPCAB.
- To compare the 'no-touch' technique with partial aortic clamping.
Main Methods:
- 700 patients undergoing multi-vessel OPCAB were analyzed.
- Comparison between 429 'no-touch' patients and 271 patients with partial aortic clamps.
- Aortic screening included manual palpation and selective epiaortic ultrasonography.
Main Results:
- The 'no-touch' group had a significantly lower stroke incidence (0.2% vs 2.2%, P = .01).
- Partial aortic clamping was the sole independent predictor of stroke (OR 28.5).
- Revascularization success was comparable between groups.
Conclusions:
- Avoiding partial aortic clamping in OPCAB improves neurologic outcomes.
- The 'no-touch' technique is reproducible and effective across varying aortic disease severities.
- This approach is recommended for OPCAB when technically feasible.