On-pump coronary artery bypass graft operation: is one cross-clamp application better than two? (original) (raw)
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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.
Interactive cardiovascular and thoracic surgery, 2008
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether, for patients undergoing coronary artery bypass grafting at higher risk of stroke, the single cross-clamp (SC) technique is of benefit in reducing the incidence of stroke. Using the reported search 458 papers were identified. Six randomised controlled trials (RCTs), of which one was a duplicate publication, represented the best evidence on the subject. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated for these. We conclude that current best available evidence, from six RCTs randomising 490 patients, suggests that there is no benefit of SC technique over multiple cross-clamp (MC) technique in terms of reduction in the incidence of stroke (SC=2/206 vs. MC=7/284; P=ns) although there is some advantage of SC technique in causing less neuropsychologica...
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.
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.
The Journal of Thoracic and Cardiovascular Surgery, 2003
Use of epiaortic scanning in coronary surgery is still a matter of debate. It is unclear whether the findings obtained by epiaortic scanning lead to effective changes in surgical technique that may reduce stroke rates. Methods: Epiaortic scanning was performed in 352 patients undergoing primary coronary artery bypass grafting before opening the pericardium using a 7.5-MHz ultrasonic probe. In the presence of moderate atherosclerosis (maximum aortic wall thickness of 3 to 5 mm), primarily single aortic crossclamping was carried out. In cases of severe sclerosis (maximum aortic wall thickness Ͼ 5 mm), aortic no-touch techniques on the beating heart were used. Results: The degree of ascending aortic atherosclerosis was normal or mild in 151 patients (42.9%), moderate in 167 patients (47.5%), and severe in 34 patients (9.6%). The operative technique was modified in 31.1% of patients with moderate aortic sclerosis and in 91.2% of patients with severe aortic sclerosis. Perioperative mortality was 0.0% for mild disease, 3.0% for moderate disease, and 8.8% for severe disease (P ϭ .005). Corresponding stroke rates reached 2.0%, 2.4%, and 2.9% (P ϭ .935). Logistic regression adjusting for EuroSCORE showed that ascending aortic atherosclerosis was an independent predictor of perioperative mortality (P ϭ .013, odds ratio 1.67, confidence interval 1.11-2.50). The influence of aortic disease on the stroke prevalence was probably due to chance (P ϭ .935), demonstrating a potentially positive effect of operative modifications concerning stroke caused by aortic manipulation. Conclusions: We conclude that intraoperative screening of coronary artery bypass grafting patients by epiaortic scanning can reveal useful information about the operative risk and with an aortic no-touch concept, perioperative stroke rates in high-risk patients may be lower than predicted. A therosclerosis of the ascending aorta has emerged as one of the most important risk factors for postoperative complications in cardiac surgery, particularly in on-pump coronary artery bypass grafting (CABG) when the diseased aorta is manipulated by cannulation and clamping. These maneuvers can be associated with intraoperative atheromatous embolization into the cerebral circulation, resulting in persistent cognitive deficit or postoperative
Safety and efficacy of off-pump coronary artery bypass grafting
The Annals of Thoracic Surgery, 2000
Background. We evaluated the application of the offpump coronary artery bypass (OPCAB) procedure relative to safety and efficiency as measured by operative mortality postoperative complications and longitudinal outcome.
Cardiovascular Journal Of Africa, 2013
AFRICA 213 Effects of single aortic clamping versus partial aortic clamping techniques on post-operative stroke during coronary artery bypass surgery IHSAN SAMI UYAR, MEHMET BESIR AKPINAR, VEYSEL SAHIN, FEYZI ABACILAR, VOLKAN YURTMAN, FAIK FEVZI OKUR, UGUR OZDEMIR, MEHMET ATES abstract Background: The aim of this study was to compare the effects of single-clamping and partial-clamping techniques on postoperative stroke during coronary artery bypass surgery. Methods: Between December 2008 and December 2012, 2 000 patients who underwent coronary artery bypass grafting in two hospitals were analysed. Post-operative neurological complications were analysed retrospectively in these patients. The cases were divided into two groups: in group 1, 1 500 patients were analysed, in whom proximal anastomosis was performed with partial clamping in a beating heart (n = 1 500, 846 male, 654 female; mean age 63.25 ± 5.72 years; range 43-78 years). In group 2, 500 patients were analysed, in whom proximal anastomosis had been performed by other surgical teams in another hospital, with cross clamping in a resting heart with cardioplegia (n = 500, 296 male, 214 female; mean age 64.83 ± 8.12 years; range 41-81 years). During 30 days post-operatively, neurological deficits, stroke incidence and the relationship of the clinical situation to mortality were analysed. Results: For both groups, patients were similar in terms of patient characteristics. In group 2, cross-clamp duration and perfusion time were longer; however, time of hospital stay was similar in the two groups. Post-operative stroke was seen in 26 patients in group 1 (1.73%) and in nine in group 2 (1.8%). The difference between the two groups was not statistically significant (p = 0.92). All stroke patients were over the age of 55 years. Seven of the stroke patients died (21.1%). In total, 31 patients died because of multiple organ failure in the postoperative 30 days (group 1: 1.6%; group 2: 1.4%) (p = 0.91).
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.