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Avoiding the clamp during off-pump coronary artery bypass reduces cerebral embolic events: results of a prospective
Hisham El Zayat1, John D Puskas, Scott Hwang
1Division of Cardiothoracic Surgery, Emory University School of Medicine, Clinical Research Unit, Atlanta, GA, USA.
Insights
A clampless facilitating device (CFD) significantly reduced cerebral embolic events during off-pump coronary artery bypass (OPCAB) surgery compared to partial clamping. This innovative approach offers a safer method for proximal aortocoronary anastomoses.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Medical Devices
Background:
- Off-pump coronary artery bypass (OPCAB) aims to reduce surgical risks.
- Cerebral embolic events remain a concern during OPCAB, particularly with aortic manipulation.
- Proximal aortocoronary anastomoses are critical steps where embolic events can originate.
Purpose of the Study:
- To compare the incidence of cerebral embolic events between a clampless facilitating device (CFD) and partial clamping for proximal aortocoronary anastomoses during OPCAB.
- To evaluate the safety and efficacy of CFD in minimizing emboli during coronary artery bypass grafting.
Main Methods:
- 57 patients with mild aortic disease (Grades I and II) were randomized to either partial clamping (CL) or CFD (Heartstring, HS).
- Cerebral embolic events (solid and gaseous) were monitored using transcranial Doppler ultrasonography.
- Proximal anastomoses were performed using either a partial-occluding clamp or the CFD.
Main Results:
- The CFD group (HS) had significantly fewer cerebral embolic events (50.8 ± 36.6) compared to the partial clamping group (CL) (90.0 ± 64.0) (P = 0.01).
- Emboli counts were lowest in patients using the CFD with a suction device.
- In the CFD group, emboli were proportional to anastomoses; in the clamp group, they were independent.
Conclusions:
- For patients with low aortic atherosclerosis burden undergoing OPCAB, using a clampless facilitating device for proximal anastomoses is associated with fewer cerebral embolic events than partial clamping.
- CFD represents a potentially safer alternative for proximal anastomoses in OPCAB surgery.
Abstract:
The purpose of this study was to determine whether a clampless facilitating device (CFD) to perform proximal aortocoronary anastomoses would result in a lower incidence of cerebral embolic events compared with a partial clamping strategy during off-pump coronary artery bypass (OPCAB). After epiaortic ultrasound confirmed the mild aortic disease (Grades I and II), 57 patients were randomly assigned to have proximal anastomoses using a partial-occluding clamp (CL, n = 28) or a CFD [Heartstring (HS), n = 29] (Maquet Cardiovascular LLC, San Jose, CA). Solid and gaseous emboli in the middle cerebral arteries were detected using transcranial Doppler ultrasonography. The mean number of proximal anastomoses was similar between groups 1.93 ± 0.72 (CL) and 1.72 ± 0.70 (HS) (P = 0.28). The mean number of gaseous plus solid emboli was greater in the CL group than the HS group (90.0 ± 64.0 vs. 50.8 ± 36.6, P = 0.01). Emboli were fewest in patients undergoing HS anastomoses using the suction device. The number of intraoperative cerebral emboli was proportional to the number of proximal anastomoses in the HS groups, but independent of the number of proximal anastomoses in the CL groups. Among patients with a low burden of aortic atherosclerosis, partial clamping of the ascending aorta during OPCAB was associated with more cerebral embolic events compared with an anastomosis with a CFD.
