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Published on: March 27, 2018
Stroke after coronary artery bypass surgery with and without cardiopulmonary bypass
Javed Iqbal1, Abdul Ghaffar, Ahmad Shahbaz
1Punjab Institute of Cardiology, Lahore, Pakistan. aw_3989@yahoo.com
Insights
Off-pump coronary artery bypass grafting (CABG) significantly reduces stroke incidence compared to on-pump CABG. This approach offers improved patient outcomes by minimizing complications associated with extracorporeal circulation.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Surgical Outcomes
Background:
- Stroke is a severe complication following coronary artery bypass grafting (CABG).
- Extracorporeal circulation used in conventional on-pump CABG may contribute to adverse neurological events.
- Investigating alternative surgical techniques is crucial for improving patient safety.
Purpose of the Study:
- To evaluate the incidence of stroke in patients undergoing off-pump coronary artery bypass grafting (OPCAB) versus conventional on-pump CABG.
- To compare the rates of other adverse outcomes, such as renal failure and myocardial infarction, between the two surgical methods.
Main Methods:
- A randomized controlled trial was conducted involving 200 patients undergoing CABG.
- Patients were divided into two groups: 100 in the on-pump group (Group A) and 100 in the off-pump group (Group B).
- Data on stroke, renal failure, myocardial infarction, and mortality were collected and analyzed within 30 days postoperatively.
Main Results:
- The off-pump CABG group showed a significantly lower incidence of stroke (1.5%) compared to the on-pump group (3.5%).
- Mortality after stroke within 30 days was 0% in the off-pump group versus 1.5% in the on-pump group.
- While renal failure was lower in the off-pump group (10% vs. 21%), acute myocardial infarction was higher (11% vs. 2%).
Conclusions:
- Off-pump CABG is associated with a significantly reduced rate of stroke compared to on-pump CABG.
- OPCAB may offer a safer alternative for patients at risk of neurological complications during coronary revascularization.
- Further research may explore optimizing OPCAB to mitigate other potential adverse events.
Background:
Stroke is a devastating complication of coronary artery bypass grafting (CABG). This study was carried out with the aim that the development of off pump coronary artery surgery decreases the incidence/adverse outcome due to extra corporeal circulation.
Methods:
The data utilized in this study was extracted from a randomized controlled trial that was conducted from January 2006 to March 2007 at Punjab Institute of Cardiology. One hundred patients were included in 'on pump' group-A, and 100 patients in 'off pump' group-B.
Results:
The mean age of the patients in group-A was 53.51 ± 9.96 years and in group-B it was 51.59 ± 10.30 years. Renal failure occurred in 21% patients of group-A as compared to 10% of group-B while Acute Myocardial Infarction occurred in significantly higher number of patients in group-B (11%) as compared to group-A (2%). Off pump was associated with significant decrease in rate of stroke 1.5% as compared to on pump 3.5%. similarly there was decreased in the risk of deaths after stroke 0% as compared to on pump 1.5% mortality after stroke. In group A 6 (3.5%) patients developed stroke where as in group-B 2 (1.5%) patients developed stroke out of these 6 patients there were 2 mortalities after stroke in group-A while in group-B there was no mortality after stroke within 30 days postoperatively.
Conclusion:
Off pump CABG is associated with significantly decreased rate of stroke in comparison with the on-pump CABG.
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