Related Experiment Video
Updated: Jun 16, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Stroke-related mortality in coronary surgery is reduced by the off-pump approach
Mariano E Brizzio1, Alex Zapolanski, Richard E Shaw
1Valley-Columbia Heart Center, Ridgewood, New Jersey 07450, USA. brizma@valleyhealth.com
Insights
Off-pump coronary artery bypass graft surgery (CABG) significantly reduces stroke risk and stroke-related mortality compared to on-pump CABG. This approach may benefit high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Public Health
Background:
- Stroke is a significant complication following coronary artery bypass graft surgery (CABG).
- The study investigates stroke frequency and mortality after on-pump versus off-pump CABG procedures.
Purpose of the Study:
- To compare the incidence of stroke and associated mortality between on-pump and off-pump CABG.
- To identify risk factors and outcomes related to stroke after CABG.
Main Methods:
- Analysis of 4,869 isolated CABG procedures (71.7% off-pump, 28.3% on-pump).
- Propensity-matched comparison of 1,379 off-pump and 1,379 on-pump cases.
- Multivariate logistic regression to assess the independent association of off-pump status with mortality after stroke.
Main Results:
- Off-pump CABG showed a lower stroke rate (1.0% vs. 2.4%, p < 0.01).
- Mortality after stroke was lower in the off-pump group (14.3% vs. 36.4%, p = 0.07).
- Off-pump status independently reduced the risk of death after stroke by 84% (aOR 0.157, p = 0.016).
Conclusions:
- Off-pump CABG is associated with reduced stroke rates and stroke-related mortality.
- Consideration of off-pump CABG may be beneficial for patients at higher risk of postoperative stroke.
Background:
Stroke remains an important complication after coronary artery bypass graft surgery (CABG). We sought to determine the frequency and death-related incidence of stroke after on-pump and off-pump CABG.
Methods:
We analyzed 4,869 consecutive isolated CABG performed in our institution. Of these, 3,490 (71.7%) were off-pump and 1,379 (28.3%) were on-pump. Propensity matched samples of 1,379 off-pump and 1,379 on-pump were compared on clinical presentation and The Society of Thoracic Surgeons (STS) predicted scores for risk of postoperative mortality and stroke. Univariate analyses were used to compare the relationship of off-pump and on-pump groups to postoperative mortality and stroke. Multivariate logistic regression was used to determine the unique association between all variables and occurrence of mortality after stroke.
Results:
No differences were found for sex, diabetes mellitus, history of renal failure, prior stroke, or timing of surgery. Postoperative mortality occurred in 75 patients (2.7%) and stroke in 47 (1.7%). The off-pump patients had a lower rate of stroke (1.0% versus 2.4%; p < 0.01) compared with on-pump patients. Mortality after stroke occurred in 14 patients, with a lower rate occurring in the off-pump group (14.3% versus 36.4%; p = 0.07). Multivariate analyses controlling for the effect of preoperative risk factors and STS mortality risk demonstrated that off-pump status was independently associated with an 84% decrease in the risk of death after stroke (adjusted odds ratio 0.157, 95% confidence interval: 0.035 to 0.711, p = 0.016).
Conclusions:
Off-pump CABG is associated with lower stroke rates and stroke-related mortality. It may be useful to consider off-pump CABG for patients who are at higher risk for postoperative stroke.
More Related Videos
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management