title: Reduced strokes in the elderly: the benefits of untouched aorta off-pump coronary surgery.
abstract: BACKGROUND
  Avoiding aortic manipulation during off-pump coronary artery bypass (OPCAB) reduces the risk for atheroembolic complications and may, thus, benefit elderly patients who are prone to atherosclerotic aortic involvement.
  
  
  METHODS
  During a period of 18 months (2000-2002), 160 consecutive OPCAB patients older than 75 years were evaluated. One hundred and three patients undergoing clampless OPCAB were compared to 57 patients in whom side clamps were applied. Clampless revascularization was achieved by in situ or T-graft arterial configurations.
  
  
  RESULTS
  Mean age was older (79.3 years vs 78.2, p = 0.049) and the prevalence (43% vs 7%, p < 0.0001) and severity of aortic disease was higher in the clampless group. The main conduits used were bilateral skeletonized internal thoracic artery (47%) and radial arteries (42%). More grafts were performed in the side-clamp group (2.5 +/- 0.5 vs 2.3 +/- 0.6, p = 0.023), however, revascularization of the postero-lateral territory was comparable. While early mortality (2.9% vs 7%, p = >or=0.05), perioperative myocardial infarction (3% vs 5%, p = >or=0.05), and sternal infections (none) were similar, the incidence of major neurological complications (0% vs 5.3%, p = 0.044) and the combined outcome of stroke or mortality (3% vs 12%, p = 0.035) were lower in the clampless group. Multivariate analysis identified side clamping as a predictor for the occurrence of stroke or mortality (OR, 6.28, CL 1.39-28.4, p = 0.017), increasing this risk by sixfold.
  
  
  CONCLUSIONS
  Clampless OPCAB is associated with reproducible neurological benefit. Improved neurological outcome may be conferred irrespective of the method of aortic screening in patients 75 years or older. The use of arterial conduits for this purpose is feasible despite the patients' advanced years.
authors.affiliation: Department of Cardiothoracic Surgery, The Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. orenlevran@hotmail.com
authors.forename: Oren
authors.initials: O
authors.lastname: Lev-Ran
authors.forename: Dan
authors.initials: D
authors.lastname: Loberman
authors.forename: Menachem
authors.initials: M
authors.lastname: Matsa
authors.forename: Dmitri
authors.initials: D
authors.lastname: Pevni
authors.forename: Nahum
authors.initials: N
authors.lastname: Nesher
authors.forename: Rephael
authors.initials: R
authors.lastname: Mohr
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*