Anaortic coronary surgery using the Π-circuit is associated with a low incidence of perioperative neurological
Sotirios Prapas1, Antonio Maria Calafiore2, Konstantinos P Katsavrias1
1Department of Cardiac Surgery, Henry Durant Hospital, Athens, Greece.
Insights
This study found that the observed rate of cerebrovascular accidents (CVA) after off-pump coronary artery bypass grafting (CABG) using the ∏-circuit no-touch technique was significantly lower than expected. The ∏-circuit is a viable option for reducing CVA risk in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Technology
Background:
- Off-pump coronary artery bypass grafting (CABG) aims to reduce complications.
- The ∏-circuit is a no-touch technique for CABG.
- Cerebrovascular accidents (CVA) are a significant postoperative concern.
Purpose of the Study:
- To compare observed versus expected rates of postoperative cerebrovascular accidents (CVA) in patients undergoing off-pump CABG using the ∏-circuit.
- To evaluate the efficacy of the ∏-circuit no-touch technique in reducing CVA and mortality.
- To identify risk factors for postoperative CVAs.
Main Methods:
- A cohort of 3081 patients undergoing off-pump CABG with the ∏-circuit from 2001-2016 was analyzed.
- CVA was defined by neurological deficit confirmed by imaging.
- Observed CVA and mortality rates were compared to expected rates using the Society of Thoracic Surgeons' calculator.
Main Results:
- The observed CVA rate was 0.5%, significantly lower than the expected 1.6% (P < 0.001).
- Observed mortality was 1.3%, also significantly lower than the expected 2.6% (P < 0.001).
- Age >70, diabetes, extracardiac vasculopathy, and chronic renal failure were identified as CVA risk factors, though the ∏-circuit remained effective except in chronic renal failure patients.
Conclusions:
- The ∏-circuit is a valuable no-touch technique for off-pump CABG.
- This technique is associated with lower-than-expected rates of CVA and mortality.
- Risk stratification can further optimize patient selection for this technique.
Objectives:
Our goal was to compare the observed and the expected rates of postoperative cerebrovascular accidents (CVA) in a large cohort of consecutive patients undergoing off-pump coronary artery bypass grafting (CABG) using the ∏-circuit as a no-touch technique.
Methods:
From January 2001 to May 2016, 3081 patients were consecutively submitted to an off-pump CABG operation using the ∏-circuit. A CVA was defined as a neurological deficit, lasting less (transient ischaemic attack) or more (stroke) than 24 h, diagnosed by a neurologist and confirmed by a computed tomography or magnetic resonance imaging scan of the brain. The primary end point was to compare the observed and the expected rates of CVAs; the latter was obtained using the Society of Thoracic Surgeons' calculator. The secondary end point was to compare the observed and the expected mortality rates using the Society of Thoracic Surgeons' calculator and the prevalence of postoperative complications. Moreover, we identified some subgroups at higher risk.
Results:
The postoperative rate of CVAs was 0.5% (14 cases): 2 (0.1%) were transient ischaemic attacks and 12 (0.4%) were strokes. The mean expected CVA rate (1.6%) was significantly higher than the observed rate (P < 0.001). None of patients who experienced postoperative CVAs died. The observed mortality was 1.3% (40 patients) vs the expected mortality (2.6%), which was significantly higher (P < 0.001). Multivariable analysis identified age >70 years old, diabetes, extracardiac vasculopathy and chronic renal failure as risk factors for postoperative CVAs. However, in all the subgroups of risk, except for those with chronic renal failure, the use of the ∏-circuit was associated with a low rate of CVAs.
Conclusions:
The ∏-circuit should be included as a possible choice among no-touch techniques. The observed rate of CVAs of 75% is lower than the expected rate.
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