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Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke

Authors: Lorusso R.; Moscarelli M.; Di Franco A.; Grazioli V.; Nicolini F.; Gherli T.; De Bonis M.; +12 Authors

Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke

Abstract

Background The impact of the coronary artery bypass grafting ( CABG ) technique (on‐ versus off‐pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series. Methods and Results A retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on‐pump CABG ( ONCAB ) or off‐pump CABG ( OPCAB ) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on‐pump versus off‐pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propensity matching were used. ONCAB procedures were performed in 17 231 cases and OPCAB in 8157. The incidence of postoperative stroke was significantly lower in the OPCAB group even after propensity matching (0.4% OPCAB versus 1.2% ONCAB , P =0.02). In the ONCAB group (but not in the OPCAB arm) the use of single aortic clamping was associated with significantly reduced postoperative stroke rate (odds ratio, 0.05; 95% CI , 0.008 to 0.07 [ P <0.001]). Conclusions OPCAB and the use of single aortic clamping in the ONCAB arm were associated with a reduced incidence of postoperative stroke. Our data confirm a strong association between aortic manipulation and neurological outcome after CABG surgery.

Countries
Switzerland, Italy, Italy, Netherlands, Italy
Keywords

AORTIC MANIPULATION, Male, PREDICTOR, off-pump, SURGERY, PUMP, coronary artery bypass grafting, Coronary Artery Bypass, Off-Pump, 610, 610 Medicine & health, aortic clamp, 2705 Cardiology and Cardiovascular Medicine, aortic clamp • coronary artery bypass grafting • off-pump • on-pump • stroke, MORBIDITY, off‐pump, Postoperative Complications, 617, Diseases of the circulatory (Cardiovascular) system, Humans, Coronary Artery Bypass, METAANALYSIS, Aorta, Original Research, Aged, Retrospective Studies, aortic clamp; coronary artery bypass grafting; off‐pump; on‐pump; stroke, RISK, OUTCOMES, on-pump, Incidence, aortic clamp; coronary artery bypass grafting; off‐pump; on‐pump; stroke;, Middle Aged, stroke, Constriction, 10020 Clinic for Cardiac Surgery, Stroke, on‐pump, CLAMP, RC666-701, Female

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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
18
Top 10%
Top 10%
Top 10%
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gold