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Off-pump surgery in preventing perioperative stroke after coronary artery bypass grafting: a retrospective multicentre study

Off-pump surgery in preventing perioperative stroke after coronary artery bypass grafting: a... OBJECTIVESTo determine the effect of the off-pump technique in preventing stroke development during the early perioperative period after coronary artery bypass graft surgery (CABG).METHODSPatients 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 IIIIV 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.RESULTSA 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; HosmerLemeshow test: 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.CONCLUSIONSOff-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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Off-pump surgery in preventing perioperative stroke after coronary artery bypass grafting: a retrospective multicentre study

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References (19)

Publisher
Oxford University Press
Copyright
The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Subject
ADULT CARDIAC
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1093/ejcts/ezt067
pmid
23435524
Publisher site
See Article on Publisher Site

Abstract

OBJECTIVESTo determine the effect of the off-pump technique in preventing stroke development during the early perioperative period after coronary artery bypass graft surgery (CABG).METHODSPatients 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 IIIIV 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.RESULTSA 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; HosmerLemeshow test: 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.CONCLUSIONSOff-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.

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Oct 22, 2013

Keywords: Coronary Stroke Off-pump

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