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Choice of hemodynamic support during coronary artery bypass surgery for prevention of stroke

Yasuyuki Shimada1, Hitoshi Yaku, Fumio Yamamoto

  • 1Department of Cardiovascular Surgery, Yuri-Kumiai General Hospital, Akita, Japan. Yasuyuki.Shimada@ma8.seikyou.ne.jp

The Journal of Extra-Corporeal Technology
|August 23, 2006
PubMed

Insights

This study developed a cerebrovascular accident (CVA) risk evaluation protocol. Implementing this protocol significantly reduced major CVA incidence in elective coronary surgery patients.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Medical Imaging

Background:

  • Coronary artery bypass grafting (CABG) carries a risk of cerebrovascular accident (CVA).
  • Pre-operative risk assessment and tailored hemodynamic support are crucial for preventing perioperative CVA.

Purpose of the Study:

  • To evaluate a protocol for cerebrovascular accident (CVA) risk assessment and hemodynamic support selection.
  • To determine if the protocol reduces major CVA incidence during elective coronary surgery.

Main Methods:

  • Retrospective analysis of 92 patients (group A) before protocol implementation and 91 patients (group B) after.
  • Utilized head CT, MRI, MRA, chest CT, carotid Doppler, carotid MRA, and ascending aorta echo for risk evaluation.
  • Hemodynamic support (arrest on pump, on-pump beating, off-pump) was selected based on risk assessment.

Main Results:

  • Major CVA incidence (modified Rankin scale 3-5) decreased from 6.6% in group A to 0% in group B (p < .05).
  • Urgent surgery cases (group C, n=9) without protocol adherence had 3 major CVA events (p < .05 vs. group B).
  • The protocol effectively eliminated major CVA in elective coronary surgery.

Conclusions:

  • The implemented protocol significantly reduces major CVA in elective coronary surgery.
  • Tailored hemodynamic support based on comprehensive CVA risk evaluation is effective.
  • A simplified risk evaluation is needed for urgent surgical cases.

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