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Published on: November 24, 2014
Association Between Proximal Anastomotic Technique and Post-operative Stroke Following Coronary Artery Bypass
Lauryn E Spinetta1, Micah Thornton2, Erin Hoover3
1Medical School, UT Southwestern Medical Center, Dallas, Texas.
Insights
This study found no difference in stroke risk between single cross clamp (SCC) and side-biting clamp (SBC) techniques during coronary artery bypass grafting (CABG). Patient history of cardiovascular accident, transient ischemic attack, and peripheral arterial disease were associated with increased stroke risk.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Clinical Outcomes Research
Background:
- Aortic clamping technique during coronary artery bypass grafting (CABG) is a debated factor influencing post-operative stroke.
- Assessing the association between proximal anastomotic technique and stroke is crucial for patient safety.
Purpose of the Study:
- To evaluate if aortic clamping technique (single cross clamp vs. side-biting clamp) impacts post-operative stroke risk in CABG patients.
- To identify patient-specific factors associated with stroke after CABG.
Main Methods:
- Retrospective analysis of a prospectively maintained single-center registry of isolated on-pump CABG cases (2013-2023).
- Stratification of patients into single cross clamp (SCC) and side-biting clamp (SBC) cohorts.
- Inverse propensity weighted multivariable regression to identify independent predictors of post-operative stroke.
Main Results:
- Stroke incidence was 2.1% across 1359 patients, with similar rates between SBC (2.1%) and SCC (2.2%) cohorts (P=0.999).
- History of cardiovascular accident (CVA), peripheral arterial disease (PAD), and transient ischemic attack (TIA) were independently associated with stroke.
- The SBC technique was not significantly associated with post-operative stroke (OR 1.04, P=0.913).
Conclusions:
- Patient history of CVA, TIA, and PAD are significant independent risk factors for stroke after CABG.
- No significant difference in stroke rates was observed between SCC and SBC aortic clamping techniques.
- Careful patient selection and assessment of aortic calcification are vital for mitigating peri-operative stroke risk.
Introduction:
The relationship between aortic clamping technique and post-operative stroke after coronary artery bypass grafting (CABG) is debated. We aimed to assess whether proximal anastomotic technique was associated with post-operative stroke at our quaternary care institution.
Methods:
We retrospectively analyzed our single-center's prospectively maintained registry, identifying all first-time, isolated on-pump CABG cases from 2013 to 2023. Patients were stratified by aortic clamping technique into single cross clamp (SCC) and side-biting clamp (SBC) cohorts. Primary outcome of interest was occurrence of post-operative stroke within 30 d of operation. Standard univariate methods were used to analyze baseline, intra-operative, and post-operative variables. Inverse propensity weighted multivariable regression identified variables independently associated with stroke.
Results:
Among 1359 patients, 662 (48.7%) underwent SBC and 697 (51.3%) SCC. Stroke incidence was 29/1359 (2.1%). There were 14 strokes in the SBC cohort (2.1%) and 15 strokes in the SCC cohort (2.2%) (P = 0.999). On inverse-weighted multivariable analysis, history of cardiovascular accident (CVA) (OR 3.27, 95% CI 1.32-8.14, P = 0.011), peripheral arterial disease (PAD) (OR 2.41, 95% CI 1.22-4.76, P = 0.011), and transient ischemic attack (TIA) (OR 2.81, 95% CI 1.01-7.82, P = 0.048) were independently associated with post-operative stroke. SBC technique was not associated with stroke (OR 1.04, 95% CI 0.49-2.22, P = 0.913).
Conclusions:
History of CVA, TIA, and PAD were independently associated with stroke after CABG. Post-operative stroke rates were similar between the SCC and SBC cohorts. We believe that careful patient selection and attention to aortic calcification is likely an important tool to mitigate peri-operative stroke risk.
