Stroke rate of off-pump coronary artery bypass; aortocoronary bypass versus in-situ bypass.
Off-pump coronary artery bypass (OPCAB) using in-situ grafts does not require aortic manipulation, and it is theoretically free from the risk of stroke. Because of the limited availability of in-situ grafts, aortocoronary bypass has been conducted in addition to in-situ grafting. In this paper, the authors prospectively investigated whether or not on aortocoronary bypass increases the incidence of stroke after off-pump bypass. Perioperative data were collected prospectively from patients who underwent isolated off-pump bypass at their hospital group between March 1997 and February 2002. The patients were divided into 2 groups; group AC (patients with at least 1 aortocoronary bypass, n = 280) and group IS (patients with all in-situ grafts, n = 234). Patients with 3-vessel disease more frequently underwent aortocoronary bypass and patients with a history of stroke, calcified ascending aorta, or renal failure more often underwent in-situ graft. The number of distal anastomoses was greater in group AC (3.5 +/- 1.0) than in group IS (2.7 +/- 1.1), p < 0.0001. Patient recovery and complication rates were similar, including the occurrence of postoperative stroke: 3.0% (7/234) in group IS vs 0.7% (2/280) in group AC, p = 0.051, NS. The graft patency and remote results were not significantly different between the 2 groups. Side clamping of the aorta used in off-pump aortocoronary bypass does not increase the risk of postoperative strokes compared to in-situ bypass. Postoperative stroke after OPCAB may depend on the patient's preoperative comorbidities.
Hirose
Hitoshi
H
Department of Cardiovascular Surgery, Kobari General Hospital, Chiba, Japan. genex@nifty.com
Amano
Atushi
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology