Alexander Albert1, Jürgen Ennker2, Yasser Hegazy3, Sebastian Ullrich4, Georgi Petrov5, Payam Akhyari5, Stefan Bauer6, Eda Ürer5, Ina Carolin Ennker7, Artur Lichtenberg5, Horst Priss8, Alexander Assmann9. 1. Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany. Electronic address: alexander.albert@med.uni-duesseldorf.de. 2. Department of Cardiac Surgery, University Clinic Oldenburg, Oldenburg, Germany; Faculty of Health, School of Medicine, University of Witten Herdecke, Witten, Germany. 3. Department of Cardiac, Thoracic, and Vascular Surgery, MediClin Heart Center Lahr/Baden, Lahr/Baden, Germany; Department of Cardio-Thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt. 4. 05 Statistics Consultants, Life Science Centre, Duesseldorf, Germany. 5. Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany. 6. Department of Cardiac, Thoracic, and Vascular Surgery, MediClin Heart Center Lahr/Baden, Lahr/Baden, Germany. 7. Department of Plastic, Aesthetic-, Hand- and Reconstructive Surgery, Hannover Medical School, Hannover, Germany. 8. Department of Neurology, Ortenau Clinic, Lahr-Ettenheim, Germany. 9. Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany; Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Abstract
OBJECTIVES: Despite substantial scientific effort, the relationship between stroke after coronary artery bypass grafting and the use of the aortic no-touch off-pump technique (anOPCAB) remains incompletely understood. The present study aimed to define the effect of anOPCAB on the occurrence and time point of stroke. METHODS: A total cohort of 15,042 consecutive patients underwent surgical myocardial revascularization at a single institution. After establishing anOPCAB as routine procedure, 4695 patients received surgery by 18 different surgeons using the anaortic approach. After the exclusion of all patients with cardiogenic shock and "side-clamp" off-pump coronary artery bypass grafting, 13,279 patients (4485 with anOPCAB) were included in the study. Perioperative strokes were classified as strokes occurring during the hospital stay, with early strokes observed immediately after emergence from anesthesia (vs delayed strokes). RESULTS: The anOPCAB technique reduced the postoperative stroke rate to 0.49% versus 1.31% in on-pump patients (P < .0001). The overall stroke rate after adoption of anOPCAB (0.64%) decreased compared with before its adoption (1.40%; P < .0001). With anOPCAB, the risk of early strokes virtually disappeared to 4 of 4485 patients (0.09%; 95% confidence interval, 0.00-0.18% vs 0.83% in on-pump patients; P < .0001), whereas the incidence of delayed strokes was not affected (0.40% vs 0.48%; P = .5181). The key results were confirmed after adjustment using propensity score-based analyses. CONCLUSIONS: The anOPCAB technique with avoidance of any aortic manipulation is an effective tool to minimize the risk of early strokes during coronary artery bypass grafting, and thus, should be considered as a routine approach. In contrast, additional preventive strategies against delayed strokes remain to be elaborated.
OBJECTIVES: Despite substantial scientific effort, the relationship between stroke after coronary artery bypass grafting and the use of the aortic no-touch off-pump technique (anOPCAB) remains incompletely understood. The present study aimed to define the effect of anOPCAB on the occurrence and time point of stroke. METHODS: A total cohort of 15,042 consecutive patients underwent surgical myocardial revascularization at a single institution. After establishing anOPCAB as routine procedure, 4695 patients received surgery by 18 different surgeons using the anaortic approach. After the exclusion of all patients with cardiogenic shock and "side-clamp" off-pump coronary artery bypass grafting, 13,279 patients (4485 with anOPCAB) were included in the study. Perioperative strokes were classified as strokes occurring during the hospital stay, with early strokes observed immediately after emergence from anesthesia (vs delayed strokes). RESULTS: The anOPCAB technique reduced the postoperative stroke rate to 0.49% versus 1.31% in on-pump patients (P < .0001). The overall stroke rate after adoption of anOPCAB (0.64%) decreased compared with before its adoption (1.40%; P < .0001). With anOPCAB, the risk of early strokes virtually disappeared to 4 of 4485 patients (0.09%; 95% confidence interval, 0.00-0.18% vs 0.83% in on-pump patients; P < .0001), whereas the incidence of delayed strokes was not affected (0.40% vs 0.48%; P = .5181). The key results were confirmed after adjustment using propensity score-based analyses. CONCLUSIONS: The anOPCAB technique with avoidance of any aortic manipulation is an effective tool to minimize the risk of early strokes during coronary artery bypass grafting, and thus, should be considered as a routine approach. In contrast, additional preventive strategies against delayed strokes remain to be elaborated.
Authors: Radosław Smoczyñski; Jakub Staromłyñski; Maciej Bartczak; Mariusz Kowalewski; Tomasz Pawłowski; Robert Gil; Dominik Drobiñski; Zbigniew Król; Waldemar Wierzba; Piotr Suwalski Journal: Kardiochir Torakochirurgia Pol Date: 2022-10-06
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Authors: Sotirios N Prapas; Ioannis A Pangiotopoulos; Vasileios N Leivaditis; Konstantinos P Katsavrias; Vasiliki S Prapa; Ioannis N Linardakis; Efstratios N Koletsis; Konstantinos Grapatsas Journal: Open J Cardiovasc Surg Date: 2019-08-27
Authors: Karel M Van Praet; Markus Kofler; Timo Z Nazari Shafti; Alaa Abd El Al; Antonia van Kampen; Andrea Amabile; Gianluca Torregrossa; Jörg Kempfert; Volkmar Falk; Husam H Balkhy; Stephan Jacobs Journal: Interv Cardiol Date: 2021-05-19