Implementation of the aortic no-touch technique to reduce stroke after off-pump coronary surgery (original) (raw)
Related papers
No-touch aorta off-pump coronary surgery: The effect on stroke
The Journal of Thoracic and Cardiovascular Surgery, 2005
Objective: Studies examining the neuroprotective effects of off-pump coronary artery bypass grafting have shown inconsistent results. Most studies, however, have not differentiated between clampless and clamp off-pump techniques. The aim of this study was to evaluate the effect of avoiding aortic manipulation on major neurologic outcomes after off-pump coronary artery bypass grafting. Methods: A total of 700 consecutive patients undergoing multiple-vessel off-pump coronary artery bypass grafting between 2000 and 2003 were included. The 429 patients undergoing aortic no-touch technique were compared with 271 patients in whom partial aortic clamps were applied. The aorta was screened by manual palpation, and epiaortic ultrasonography was used selectively. Results: The frequency of detected atherosclerotic aortic disease was higher in the no-touch group (17.4% vs 5.1%, P Ͻ .0001). No-touch revascularization was achieved with arterial conduits, arranged in T-graft or in situ configurations (50%). The respective graft/patient ratios were 2.5 Ϯ 0.6 and 2.6 Ϯ 0.6 in the side-clamp and no-touch groups (P ϭ .009); however, revascularization of the posterolateral myocardial territory was comparable (87% vs 90%, difference not significant). The incidence of stroke (0.2% vs 2.2%, P ϭ .01) was significantly lower in the no-touch group (1/429). Logistic regression identified partial aortic clamping as the only independent predictor of stroke (odds ratio 28.5, confidence interval 0.22-333, P ϭ .009), increasing this risk 28-fold. Peripheral vascular disease (P ϭ .068), diabetes (P ϭ .072), and history of stroke (P ϭ .074) trended toward stroke. Conclusions: Avoiding partial aortic clamping during off-pump coronary artery bypass grafting provides superior neurologic outcome. The results are reproducible and irrespective of the severity of aortic disease or the method of aortic screening. This technique is recommended whenever technically feasible.
Background and Aims: Conventional coronary artery bypass grafting (CCABG) has been associated with high incidence of stroke, especially for the high degree of aortic manipulation. Off-pump CABG (OPCAB) theoretically represents a valid option, since the avoidance of aortic manipulation can prevent the embolization of atherosclerotic debris. There is a lot of controversy about the outcomes of CCABG compared to OPCAB. The aim of this metanalysis is to examine the incidence of stroke within 30 days from the surgical procedure.
Cardiology and Cardiovascular Medicine, 2019
Background and Aims: Conventional coronary artery bypass grafting (CCABG) has been associated with high incidence of stroke, especially for the high degree of aortic manipulation. Off-pump CABG (OPCAB) theoretically represents a valid option, since the avoidance of aortic manipulation can prevent the embolization of atherosclerotic debris. There is a lot of controversy about the outcomes of CCABG compared to OPCAB. The aim of this metanalysis is to examine the incidence of stroke within 30 days from the surgical procedure. Methods and Results: A literature search was conducted from 2009 to 2019 using PubMed database. Nine randomized control trials were included in the metanalysis.
Assessing the benefits of anaortic off-pump coronary artery bypass grafting
Frontiers in cardiovascular medicine, 2024
Introduction: The procedure called the "aorta no-touch" (NT) or anaortic technique in off-pump coronary artery bypass grafting (OPCAB) is designed to reduce the perioperative risk of stroke. We have observed an increased frequency of anaortic OPCAB procedures at our institution. The main purpose of the present study is to investigate the effectiveness of anaortic OPCAB in reducing the perioperative risk of stroke. Methods: From April 2011 to July 2023, a total of 2,236 patients underwent isolated OPCAB at our single center. The patients were divided into the anaortic group (NT, n = 762) and the aortic group (A, n = 1,474). The NT group was propensity score-matched (PSM) with the A group at a 1:1 ratio (NT n = 640; A n = 640), and matching was performed based on 26 covariates with preoperative clinical characteristics. Results: In both the unmatched and matched cohorts of the NT and A groups, there were no significant differences observed in new stroke rates (NT vs. A; unmatched, 1.0% vs. 1.2%, p = 0.624; matched, 0.9% vs. 1.3%, p = 0.789). The univariable logistic analysis did not identify the anaortic technique as an independent factor negatively associated with new stroke events (OR = 0.81, 95% CI = 0.35-1.86, p = 0.624). Conclusion: The present study did not find the anaortic technique to reduce the perioperative risk of stroke in OPCAB. Hence, further large studies are needed to identify patient cohorts in which anaortic OPCAB is significantly beneficial.
Incidence of stroke in onpump versus offpump coronary artery bypass grafting a metanalysis
Background and Aims: Conventional coronary artery bypass grafting (CCABG) has been associated with high incidence of stroke, especially for the high degree of aortic manipulation. Off-pump CABG (OPCAB) theoretically represents a valid option, since the avoidance of aortic manipulation can prevent the embolization of atherosclerotic debris. There is a lot of controversy about the outcomes of CCABG compared to OPCAB. The aim of this metanalysis is to examine the incidence of stroke within 30 days from the surgical procedure.
Proposed Strategy for Stroke Reduction in Coronary Bypass Surgery
Background: Perioperative stroke can prove to be a detrimental complication after cardiac surgery. The purpose of this study is to determine if the combined use of epiaortic ultrasound and cerebral oximetry in patients undergoing on-pump coronary bypass surgery reduces the incidence of perioperative stroke. Methods: In 306 consecutive patients undergoing on-pump surgery, epiaortic ultrasound and cerebral oximetry were utilized. A stroke risk index was utilized to calculate the predicted risk of stroke for the entire population and in high-risk sub groups. The observed and expected rates of perioperative stroke were compared. Results: Two patients (0.7%, 95% CI: 0.18%-2.4%) patients suffered a perioperative stroke - lower than the expected risk of stroke (2.99%). We also investigated the risk of stroke in some high-risk patients. In patients with documented atherosclerosis of the ascending aorta, the stroke rate was 2.90% (95% CI: 0.51-14.50%), compared to the expected rate of 4.71%; in patients with vascular disease, it was 0.84% (95% CI: 0.15%-4.61%), versus the expected rate of 4.64%; and in patients older than 70 years, it was 0% (95% CI: 0%-92%), while the expected rate was 5.13%. There were no transient ischemic attacks, coma or mortality associated with neurological adverse events. Conclusions: This simple intraoperative strategy seems to be effective in reducing the incidence of perioperative stroke in patients undergoing on-pump surgery, even in relatively high-risk populations. This strategy is simple, practical, non time-consuming and is easily applicable in a variety of settings.
Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke
Journal of the American Heart Association
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 propen...
European Journal of Cardio-Thoracic Surgery, 2013
OBJECTIVES: To determine the effect of the off-pump technique in preventing stroke development during the early perioperative period after coronary artery bypass graft surgery (CABG). METHODS: Patients undergoing isolated CABG surgery were enrolled from 21 Spanish cardiac-surgery centres. Baseline variables related to perioperative stroke risk were recorded in the preoperative (age, gender, diabetes mellitus, arterial hypertension, prior stroke, cardiac failure: preoperative New York Heart Association class III-IV and/or left ventricular ejection fraction <40%, non-elective priority of surgery, peripheral arteriopathy, chronic renal failure) and intraoperative periods (on/off-pump performance). The Northern New England Cardiovascular Disease Study Group (NNECDSG) stroke risk schema was used to stratify stroke risk and compare observed neurological outcomes in this study. RESULTS: A total of 26 347 patients were included in the study. Global perioperative stroke incidence was 1.38%. Non-elective priority of surgery (OR = 2.37), peripheral arteriopathy (OR = 1.62), cardiac failure (OR = 2.98), prior stroke (OR = 1.57) and chronic renal failure (OR = 6.16) were found to be independent risk factors for perioperative stroke in uni-and multivariate models; Hosmer-Lemeshow test: χ 2 = 4.62, P = 0.59. Perioperative stroke incidence increased whenever NNECDSG score or the number of preoperative risk factors increased. However, on-vs off-pump surgery did not show statistical differences in NNECDSG strata. For patients with two or more preoperative independent risk factors, off-pump surgery showed a significant reduction in perioperative stroke incidence (4.29 vs 6.76%, P < 0.05), particularly when one of these factors was chronic renal failure or preoperative cardiac failure. However, when both factors were present concomitantly there was no difference between on and off-pump techniques, P < 0.0001. CONCLUSIONS: Off-pump surgery has a lower perioperative stroke incidence than on-pump only in cases associated with cardiovascular stroke-risk factors, in particular, with chronic renal failure and preoperative cardiac failure, but also with peripheral arteriopathy, prior stroke and non-elective surgery. The perioperative stroke rate remains high in cases with two or more preoperative stroke risk factors, even when using the off-pump technique, particularly when chronic renal failure is present.