Related Experiment Videos
Comparison of on pump and off pump coronary surgery: risk factors for neurological outcome
Erminio Sisillo1, Maria Rosaria Marino, Glauco Juliano
1Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy.
Insights
Off-pump coronary bypass grafting (OPCAB) did not show a lower risk of stroke compared to conventional coronary artery bypass grafting (CCABG). Our study found similar rates of cerebrovascular accidents (CVA) between the two surgical approaches.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Technology
Background:
- Coronary artery bypass grafting (CABG) can lead to devastating cerebrovascular accidents (CVA).
- Conventional CABG (CCABG) has a reported CVA incidence of 3-6%.
- Off-pump CABG (OPCAB) is theorized to reduce neurological complications, but evidence is debated.
Purpose of the Study:
- To investigate if OPCAB is associated with lower neurological morbidity compared to CCABG.
- To compare the incidence of perioperative stroke between OPCAB and CCABG in our patient cohort.
Main Methods:
- A retrospective analysis of 8002 isolated CABG patients (1998-2005).
- 1415 patients underwent OPCAB; the rest had CCABG.
- Multiple logistic regression was used to analyze neurological outcomes based on surgical technique.
Main Results:
- OPCAB patients were older and had more renal injury and redo interventions.
- CCABG patients had more urgent operations and less hypertension.
- Cerebrovascular accident (CVA) incidence was similar: Type I (0.70% OPCAB vs. 0.68% CCABG) and Type II (0.70% OPCAB vs. 0.83% CCABG).
Conclusions:
- Conventional CABG (CCABG) did not demonstrate a higher risk of neurological adverse events compared to OPCAB.
- The study suggests OPCAB may not offer a significant neurological benefit over CCABG in terms of stroke risk.
Objective:
Cerebrovascular accidents (CVA) are devastating complications after coronary artery bypass grafting (CABG). The reported incidence of neurological complications after conventional CABG (CCABG) is 3-6%. Off-pump coronary bypass grafting (OPCAB) has been associated in recent studies to a decreased morbidity and risk of perioperative stroke. Nevertheless, uncertainty still surrounds the relative benefits of OPCAB. We investigated whether, in our experience, OPCAB was associated with lower neurological morbidity than conventional CABG approach.
Methods:
Eight thousand and two patients underwent isolated CABG at our institution between January 1998 and January 2005. OPCAB operation was performed on 1415 patients. Data were prospectively collected. A multiple logistic regression analysis was used to evaluate the influence of the two different surgical techniques on the neurological outcomes.
Results:
Patients in the OPCAB group were significantly older (66.2 vs 63.5%, p<0.0001), had a higher incidence of renal injury (5.4 vs 2.4%, p<0.0001), and were more redo interventions (6.95 vs 1.53%, p<0.0001). The CCABG patients were more urgent at operation (5.46 vs 3.26, p=0.0007), were less hypertensive (57.6 vs 63% of the patients, p=0.0003) more diabetics (22 vs 20.6%, NS), and had an ejection fraction less than 0.40 (10.4 vs 9.6%, NS). CVA incidence was similar in both groups (Type I outcome: OPCAB=0.70% vs CCABG=0.68%, p=0.91; Type II outcome OPCAB=0.70% vs CCABG=0.83%, p=0.63).
Conclusions:
In our experience patients undergoing CCABG were not exposed to a greater risk of neurological adverse events when compared to OPCAB patients.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management