The impact of coronary artery bypass grafting surgical technique on stroke in young and elderly patients.
BACKGROUND
Today, the elderly represent a large and rapidly growing segment of society and are being referred in increasing numbers for coronary artery bypass grafting (CABG) surgery. Stroke is a major complication of CABG surgery. The risk of stroke after CABG can be managed successfully, especially in high-risk patients, by choosing an adequate and appropriate surgical technique.


METHODS
We evaluated 890 consecutive patients who underwent isolated CABG surgery by the same team between June 2006 and July 2008. The patients were divided by age into 2 groups. Group I consisted of 480 patients <65 years of age, and group II comprised 410 patients >65 years of age. Each group was then divided into 4 subgroups according to the surgical technique used: double-clamp technique (DCT), single-clamp technique (SCT), off-pump, and on-pump cross-clamp off. Preoperative risk factors for stroke and all clinical data were collected for the patients.


RESULTS
In group I, 192 (40%) of the patients were female, and 288 (60%) were male. In group II, 170 (41.5%) were female, and 240 (58.5%) were male. Five patients in each group experienced stroke, with an incidence of 1.04% in group I (4 men and 1 woman) and 1.21% in group II (3 men and 2 women). The stroke rates of the 2 age groups were not significantly different (P= .802). Three of the 480 patients in group I died, with only 1 (33.3%) of the deaths related to stroke. In group II, however, 2 (50%) of the 4 deaths were related to stroke. The incidences of stroke-associated mortality in the 2 age groups were not significantly different (P=1.0).


CONCLUSIONS
Although off-pump and on-pump cross-clamp off techniques were performed for some of the patients, DCT and SCT were used for the majority of the patients. We detected no statistically significant difference between these 2 groups of patients in the impact of applying DCT and SCT on the stroke rate. We conclude that this result was due to the different surgical techniques performed on a minority of the patients (82 patients).
Teskin
Onder
O
Division of Cardiovascular Surgery, Anadolu Health Center, Izmit, Turkey. oteskin@hotmail.com
Bicer
Yesim
Y
Kaya
Ugur
U
Cicek
Sertac
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult