Related Experiment Video
Updated: Feb 10, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Implementation of the aortic no-touch technique to reduce stroke after off-pump coronary surgery
Alexander Albert1, Jürgen Ennker2, Yasser Hegazy3
1Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
Insights
The aortic no-touch off-pump coronary artery bypass grafting (anOPCAB) technique significantly reduces early stroke risk after surgery. This method, avoiding aortic manipulation, is recommended for routine use to improve patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Clinical Outcomes Research
Background:
- Stroke is a significant complication following coronary artery bypass grafting (CABG).
- The impact of the aortic no-touch off-pump technique (anOPCAB) on stroke occurrence and timing remains unclear.
- Understanding stroke risk factors in CABG is crucial for patient safety.
Purpose of the Study:
- To determine the effect of the anOPCAB technique on the incidence and timing of stroke after CABG.
- To compare stroke rates between anOPCAB and conventional on-pump CABG.
- To evaluate the efficacy of avoiding aortic manipulation in preventing perioperative strokes.
Main Methods:
- Retrospective analysis of 13,279 patients undergoing myocardial revascularization.
- Comparison between 4485 patients who received anOPCAB and those who had on-pump CABG.
- Classification of perioperative strokes into early (immediate post-anesthesia) and delayed strokes.
Main Results:
- The anOPCAB technique was associated with a significantly lower postoperative stroke rate (0.49% vs. 1.31% for on-pump; P < .0001).
- Early stroke risk was virtually eliminated with anOPCAB (0.09% vs. 0.83% for on-pump; P < .0001).
- The incidence of delayed strokes was not significantly different between the two techniques (0.40% vs. 0.48%; P = .5181).
Conclusions:
- The anOPCAB technique effectively minimizes the risk of early strokes during CABG.
- Avoiding aortic manipulation with anOPCAB should be considered a routine surgical approach.
- Further research is needed to develop strategies for preventing delayed strokes after CABG.
Objectives:
Despite substantial scientific effort, the relationship between stroke after coronary artery bypass grafting and the use of the aortic no-touch off-pump technique (anOPCAB) remains incompletely understood. The present study aimed to define the effect of anOPCAB on the occurrence and time point of stroke.
Methods:
A total cohort of 15,042 consecutive patients underwent surgical myocardial revascularization at a single institution. After establishing anOPCAB as routine procedure, 4695 patients received surgery by 18 different surgeons using the anaortic approach. After the exclusion of all patients with cardiogenic shock and "side-clamp" off-pump coronary artery bypass grafting, 13,279 patients (4485 with anOPCAB) were included in the study. Perioperative strokes were classified as strokes occurring during the hospital stay, with early strokes observed immediately after emergence from anesthesia (vs delayed strokes).
Results:
The anOPCAB technique reduced the postoperative stroke rate to 0.49% versus 1.31% in on-pump patients (P < .0001). The overall stroke rate after adoption of anOPCAB (0.64%) decreased compared with before its adoption (1.40%; P < .0001). With anOPCAB, the risk of early strokes virtually disappeared to 4 of 4485 patients (0.09%; 95% confidence interval, 0.00-0.18% vs 0.83% in on-pump patients; P < .0001), whereas the incidence of delayed strokes was not affected (0.40% vs 0.48%; P = .5181). The key results were confirmed after adjustment using propensity score-based analyses.
Conclusions:
The anOPCAB technique with avoidance of any aortic manipulation is an effective tool to minimize the risk of early strokes during coronary artery bypass grafting, and thus, should be considered as a routine approach. In contrast, additional preventive strategies against delayed strokes remain to be elaborated.
Related Concept Videos
02:26Responses to Gravity and Touch
01:30ATP Driven Pumps III: V-type Pumps
The peripheral or cytosolic V1 domain with eight subunits is involved in ATP hydrolysis. The integral or transmembrane V0 domain containing at least five subunits...
01:34ATP Driven Pumps II: P-type Pumps
A typical P-type pump has three cytosolic domains: nucleotide-binding (N), phosphorylation (P), and activator (A) domains. These domains are connected to the membrane-spanning helices by short amino acid segments. ATP hydrolysis and covalent phosphoenzyme intermediate formation are crucial parts of the catalytic cycle. At the highly...
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:13Pumped Concrete
For direct-acting pumps, the concrete enters the pump via the inlet valve under the action of gravity and suction created by the movement of the piston. This concrete is then forced into the pipeline and out through the outlet valve by the forward movement...
01:15Techniques of therapeutic communication I: Active Listening, Sharing Observations, Validation, and Using Touch
Therapeutic communication is not the same as social interaction. Social interaction has no goal or purpose and consists of casual information sharing, whereas therapeutic communication has a plan or purpose for the conversation. Therapeutic...