Comparison of on pump and off pump coronary surgery: risk factors for neurological outcome.
OBJECTIVE
Cerebrovascular accidents (CVA) are devastating complications after coronary artery bypass grafting (CABG). The reported incidence of neurological complications after conventional CABG (CCABG) is 3-6%. Off-pump coronary bypass grafting (OPCAB) has been associated in recent studies to a decreased morbidity and risk of perioperative stroke. Nevertheless, uncertainty still surrounds the relative benefits of OPCAB. We investigated whether, in our experience, OPCAB was associated with lower neurological morbidity than conventional CABG approach.


METHODS
Eight thousand and two patients underwent isolated CABG at our institution between January 1998 and January 2005. OPCAB operation was performed on 1415 patients. Data were prospectively collected. A multiple logistic regression analysis was used to evaluate the influence of the two different surgical techniques on the neurological outcomes.


RESULTS
Patients in the OPCAB group were significantly older (66.2 vs 63.5%, p<0.0001), had a higher incidence of renal injury (5.4 vs 2.4%, p<0.0001), and were more redo interventions (6.95 vs 1.53%, p<0.0001). The CCABG patients were more urgent at operation (5.46 vs 3.26, p=0.0007), were less hypertensive (57.6 vs 63% of the patients, p=0.0003) more diabetics (22 vs 20.6%, NS), and had an ejection fraction less than 0.40 (10.4 vs 9.6%, NS). CVA incidence was similar in both groups (Type I outcome: OPCAB=0.70% vs CCABG=0.68%, p=0.91; Type II outcome OPCAB=0.70% vs CCABG=0.83%, p=0.63).


CONCLUSIONS
In our experience patients undergoing CCABG were not exposed to a greater risk of neurological adverse events when compared to OPCAB patients.
Sisillo
Erminio
E
Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy.
Marino
Maria Rosaria
MR
Juliano
Glauco
G
Beverini
Cristina
C
Salvi
Luca
L
Alamanni
Francesco
F
D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D016896:Treatment Outcome