Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke

Medientyp: E-Artikel
Titel: Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke
Beteiligte: Lorusso, Roberto; Moscarelli, Marco; Di Franco, Antonino; Grazioli, Valentina; Nicolini, Francesco; Gherli, Tiziano; De Bonis, Michele; Taramasso, Maurizio; Villa, Emmanuel; Troise, Giovanni; Scrofani, Roberto; Antona, Carlo; Mariscalco, Giovanni; Beghi, Cesare; Miceli, Antonio; Glauber, Mattia; Ranucci, Marco; De Vincentiis, Carlo; Gaudino, Mario
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2019
Erschienen in: Journal of the American Heart Association
Sprache: Englisch
DOI: 10.1161/jaha.119.013650
ISSN: 2047-9980
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Beschreibung: <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> The impact of the coronary artery bypass grafting ( <jats:styled-content style="fixed-case">CABG</jats:styled-content> ) 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 <jats:styled-content style="fixed-case">CABG</jats:styled-content> series. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> A retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated <jats:styled-content style="fixed-case">CABG</jats:styled-content> procedures with on‐pump CABG ( <jats:styled-content style="fixed-case">ONCAB</jats:styled-content> ) or off‐pump CABG ( <jats:styled-content style="fixed-case">OPCAB</jats:styled-content> ) 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. <jats:styled-content style="fixed-case">ONCAB</jats:styled-content> procedures were performed in 17 231 cases and <jats:styled-content style="fixed-case">OPCAB</jats:styled-content> in 8157. The incidence of postoperative stroke was significantly lower in the <jats:styled-content style="fixed-case">OPCAB</jats:styled-content> group even after propensity matching (0.4% <jats:styled-content style="fixed-case">OPCAB</jats:styled-content> versus 1.2% <jats:styled-content style="fixed-case">ONCAB</jats:styled-content> , <jats:italic>P</jats:italic> =0.02). In the <jats:styled-content style="fixed-case">ONCAB</jats:styled-content> group (but not in the <jats:styled-content style="fixed-case">OPCAB</jats:styled-content> arm) the use of single aortic clamping was associated with significantly reduced postoperative stroke rate (odds ratio, 0.05; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 0.008 to 0.07 [ <jats:italic>P</jats:italic> <0.001]). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">OPCAB</jats:styled-content> and the use of single aortic clamping in the <jats:styled-content style="fixed-case">ONCAB</jats:styled-content> arm were associated with a reduced incidence of postoperative stroke. Our data confirm a strong association between aortic manipulation and neurological outcome after <jats:styled-content style="fixed-case">CABG</jats:styled-content> surgery. </jats:p> </jats:sec>
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