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Published on: September 15, 2023
Off-pump coronary artery bypass grafting reduces postoperative neurologic complications
Alberto Zangrillo1, Giuseppe Crescenzi, Giovanni Landoni
1Department of Cardiovascular Anesthesia, IRCCS San Raffaele Hospital, Milan, Italy.
Insights
Off-pump coronary artery bypass graft (CABG) surgery is associated with fewer major neurologic complications compared to using cardiopulmonary bypass (CPB). This finding suggests potential benefits of the off-pump technique for patient neurological outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Complications
Background:
- Neurologic damage is a significant concern following coronary artery bypass graft (CABG) surgery.
- Cardiopulmonary bypass (CPB) has been implicated as a primary cause of these neurologic complications.
Purpose of the Study:
- To compare the postoperative outcomes of patients undergoing CABG surgery.
- To specifically evaluate and compare the incidence of neurologic events between CABG performed with and without CPB.
Main Methods:
- An observational study was conducted at a university tertiary care hospital.
- Data from 2,740 consecutive patients who underwent CABG between January 1998 and January 2003 were analyzed.
- Patients were divided into an off-pump (OP) group (738 patients) and a cardiopulmonary bypass (CPB) group (2,002 patients).
Main Results:
- The CPB group exhibited a higher incidence of type I neurologic events (2.1%) compared to the OP group (0.9%), with an odds ratio of 2.6.
- Independent predictors for postoperative neurologic events included a history of previous stroke (OR: 2.7) and advanced age (OR: 1.06 per year).
Conclusions:
- Off-pump CABG surgery demonstrated benefits over CPB regarding major neurologic complications.
- The findings suggest that the off-pump technique may reduce the risk of neurological adverse events in CABG patients.
Objective:
Complications occurring after coronary artery bypass graft (CABG) surgery, particularly neurologic damage, have been mainly correlated with the use of cardiopulmonary bypass (CPB). The aim of this work was to compare postoperative outcomes of patients undergoing CABG surgery, with or without the use of CPB, focusing on neurologic events.
Design:
Observational study.
Setting:
University tertiary care hospital.
Participants:
Two thousand seven hundred and forty consecutive patients who underwent CABG surgery in the period January 1998 to January 2003.
Interventions:
None.
Measurements And Main Results:
For 738 patients, the operation was performed off-pump (OP group), and for 2002 patients CPB was used (CPB group). OP and CPB groups were compared with regard to preoperative status, anesthetic management, and postoperative outcomes, by means of univariate and multivariate analyses. Surgeons' propensity to operate off-pump was based on patients' age, renal conditions, and hemodynamics. Univariate and multivariate analyses showed that CPB was associated with a higher incidence of type I neurologic events compared with OP technique (2.1% versus 0.9%, odds ratio [OR]: 2.6, 95% confidence interval [CI], 1.2-5.9). A history of previous stroke (OR: 2.7, 95% CI, 1.2-5.9) and advanced age (OR: 1.06 per year, 95% CI, 1.02-1.09) were additional independent predictors of postoperative type I neurologic events.
Conclusions:
In the authors' experience, off-pump CABG surgery offers some benefits compared with CPB in respect to major neurologic complications.
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