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Published on: September 15, 2023
A Partial Clamp During Off-Pump Coronary Artery Bypass Grafting Can be Safely Used When Utilizing the Calcium Score
Goto Yoshihiro1, Sho Takagi1, Junji Yanagisawa1
1Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan. yoshihiro.goto57@gmail.com.
Insights
Partial clamping (PC) does not increase stroke risk compared to clampless devices (CFD) during off-pump coronary artery bypass grafting (OPCAB), even with high aortic calcium scores. This study evaluated aortic calcium scores to assess stroke incidence in different OPCAB clamping strategies.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Neurosurgery
Background:
- Aortic calcification assessment is crucial for surgical planning in coronary artery bypass grafting.
- The utility of calcium scoring for evaluating the aorta during partial clamping (PC) in off-pump coronary artery bypass grafting (OPCAB) remains unestablished.
- Previous studies have not investigated the impact of aortic calcium score on stroke incidence with different clamping strategies.
Purpose of the Study:
- To investigate the effect of different aortic clamping strategies on postoperative stroke incidence during OPCAB.
- To determine if aortic calcium score influences stroke risk in patients undergoing OPCAB with partial clamping (PC) versus clampless facilitating anastomotic devices (CFD).
Main Methods:
- Retrospective review of 339 patients undergoing isolated OPCAB between August 2013 and March 2021.
- Patients were divided into two groups: partial clamping (PC) for proximal anastomoses (n=130) and clampless facilitating anastomotic device (CFD) (n=107).
- Preoperative CT scans were used to calculate the Agatston calcium score of the ascending aorta.
Main Results:
- The Agatston calcium score was significantly higher in the CFD group (1819.8 ± 2391.5) compared to the PC group (29.7 ± 66.5) (P < 0.001).
- No significant differences were observed in the number of distal anastomoses or operative time between the groups.
- Thirty-day follow-up revealed three strokes (two in the PC group, 1.5%; one in the CFD group, 0.9%), with no statistically significant difference (P = 0.98).
Conclusions:
- Partial clamping (PC) does not elevate the risk of postoperative stroke compared to using a clampless facilitating anastomotic device (CFD) in OPCAB.
- Aortic calcium score evaluation does not appear to alter the stroke incidence between PC and CFD strategies in OPCAB.
- The findings suggest that PC is a safe alternative to CFD regarding stroke risk in OPCAB, irrespective of aortic calcification severity.
Background:
No previous study has shown that the volume of calcium score is useful for evaluating the aorta when performing a partial clamp (PC). The purpose of this study was to examine the effect of different clamping strategies during off-pump coronary artery bypass grafting (OPCAB), in terms of the incidence of postoperative stroke using the calcium score of the ascending aorta.
Methods:
We retrospectively reviewed 339 patients, who underwent isolated OPCAB between August 2013 and March 2021. There were two groups of patients, depending on the procedure. A PC was used for proximal anastomoses in 130 (38.3%) patients. A clampless proximal facilitating anastomotic device (CFD) was used in 107 (31.5%) patients. We prescribed preoperative CT for all patients, and the Agatston score was used.
Results:
The calcium score significantly was higher in the CFD group than in the PC group (29.7 ± 66.5 vs. 1819.8 ± 2391.5, < 0.001). The number of distal anastomoses and operative time were not significantly different between the two groups. There was no mortality and three strokes occurred at the 30-day follow up. Two strokes occurred in the PC group (1.5%) and one in the CFD group (0.9%), which was not significantly different (P = 0.98).
Conclusion:
A PC does not increase postoperative stroke incidence compared with a CFD, when utilizing calcium score evaluation in OPCAB.
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