title: A multimodal approach to the prevention of postoperative stroke in patients undergoing coronary artery bypass surgery.
abstract: BACKGROUND
  Stroke is known to be multifactorial in origin. This study was designed to assess the effectiveness of a multimodal approach to preventing this complication in patients undergoing coronary artery bypass.
  
  
  METHODS
  One thousand five hundred thirty consecutive coronary artery bypass patients operated on by a single surgeon from July 1994 to April 2008 were studied. Group 1 patients (n = 1,214) were operated on before 2004. Group 2 patients (n = 316) were operated on after 2004. In group 2 patients, epiaortic scanning, selective use of proximal anastomotic devices, and alternative cannulation were used. Off-pump coronary artery bypass (OPCAB) was used in 730 patients. On-pump coronary artery bypass (ONCAB) was used in 800 patients. Preoperative risk factors including age, cerebrovascular disease, peripheral vascular disease, hypertension, and diabetes were examined in all patients. The incidence of postoperative stroke was determined for group 1 and 2 patients and the individual cohorts of OPCAB and ONCAB patients.
  
  
  RESULTS
  The overall incidence of stroke was 1.6% (25/1,530). The postoperative incidence of stroke was 1.7% (21/1,214) in group 1 patients as compared with 1.3% (4/316) in group 2 patients. The incidence of postoperative stroke was 2.4% (19/800) in ONCAB patients as compared with 0.8% (6/730) in OPCAB patients (P < .05).
  
  
  CONCLUSIONS
  OPCAB is an important tool for the prevention of postoperative stroke. Adjunctive techniques for the prevention of emboli from the ascending aorta may also reduce the risk of stroke in OPCAB and ONCAB patients.
authors.affiliation: Cardiothoracic Surgery Associates, PeaceHealth Medical Group, St Joseph Hospital, Bellingham, WA 98225, USA. JDouglas@PeaceHealth.org
authors.forename: James M
authors.initials: JM
authors.lastname: Douglas
authors.forename: Susan E
authors.initials: SE
authors.lastname: Spaniol