Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational...

Area of Science:

• Cardiovascular Surgery
• Neurological Complications
• Medical Device Technology

Background:

• Stroke is a serious complication following coronary artery bypass grafting (CABG), with incidence ranging from 1.4% to 4.3%.
• Cerebral embolization from aortic atheromatous debris or calcified plaques is a primary cause of post-CABG stroke.
• The clampless surgical concept aims to mitigate this risk by avoiding aortic side-clamping.

Purpose of the Study:

• To analyze the incidence of stroke in patients undergoing off-pump coronary artery bypass surgery (OPCAB).
• To evaluate the efficacy of the HEARTSTRING device in facilitating clampless aortic anastomosis during OPCAB.
• To assess the safety and effectiveness of avoiding aortic side-clamping in reducing postoperative stroke rates.

Main Methods:

• A cohort of 412 consecutive patients underwent OPCAB with the HEARTSTRING device over 43 months (2005-2008).
• A minimum of one proximal aortic anastomosis was performed per patient, totaling 542 anastomoses created using the HEARTSTRING device.
• One surgeon performed all procedures, adhering to the clampless surgical concept.

Main Results:

• The study included patients with a mean age of 67 years; predicted mortality was 5.2%, with an observed mortality of 1.9%.
• 15% of patients had a history of preoperative neurological or cerebrovascular disease.
• The overall postoperative stroke incidence was 0.48%, significantly lower than the 1.3% predicted by the stroke risk score.

Conclusions:

• Avoiding aortic side-clamping during OPCAB, as facilitated by the HEARTSTRING device, demonstrably reduces postoperative stroke rates.
• The HEARTSTRING device is confirmed as a safe and effective option for creating proximal aortic anastomoses in clampless OPCAB procedures.
• These findings support the clampless surgical concept for enhancing patient safety in CABG surgery.