Off versus on pump myocardial revascularization in patients with severe asymptomatic carotid stenosis

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Vascular Surgery

Background:

• Coronary artery disease (CAD) is a leading global health concern, frequently treated with coronary artery bypass grafting (CABG).
• Severe asymptomatic carotid stenosis presents a complex challenge in CABG patients, necessitating careful surgical technique selection.
• This study evaluates off-pump versus on-pump CABG in this specific high-risk population.

Purpose of the Study:

• To compare perioperative stroke incidence between off-pump and on-pump CABG in patients with severe asymptomatic carotid stenosis.
• To assess secondary outcomes including postoperative delirium, mortality, and length of hospital stay.
• To evaluate long-term survival rates following both surgical techniques.

Main Methods:

• Retrospective single-center analysis of 243 patients with severe asymptomatic carotid stenosis undergoing CABG.
• Propensity score-matched pair analysis comparing 78 patients in the off-pump group with 78 patients in the on-pump group.
• Primary endpoint: perioperative stroke; secondary endpoints: mortality, delirium, hospital stay, and long-term survival.

Main Results:

• Perioperative stroke occurred significantly less often in the off-pump group (1.3%) versus the on-pump group (10.3%, P=0.03).
• No significant differences were observed in intrahospital mortality, intensive care unit stay, or length of hospitalization.
• Long-term survival rates were comparable between the off-pump and on-pump CABG groups.

Conclusions:

• Off-pump CABG demonstrates a significant reduction in perioperative stroke risk for patients with severe asymptomatic carotid stenosis.
• The off-pump technique does not negatively impact short-term or long-term patient outcomes.
• Preference for off-pump CABG is supported in this population, emphasizing personalized surgical strategies.