title: Off-pump coronary artery bypass grafting with an aortic nonclamping technique may reduce the incidence of cerebral complications.
abstract: OBJECTIVE
  Cerebrovascular accidents after coronary artery bypass grafting (CABG) remain a complication despite the advancements in techniques. Aortic partial clamping should be avoided to prevent this cerebral complication. We use pedicle arterial grafts (bilateral internal-mammary arteries and the right gastroepiploic artery) and saphenous vein graft with a proximal anastomosis device for off-pump CABG without aortic partial clamping. We call this technique the aortic nonclamping technique.
  
  
  METHODS
  Between 2001 and 2007, a total of 468 patients underwent coronary bypass operations; 8 who were operated on with cardiopulmonary bypass were excluded from this study. Altogether, 451 patients underwent off-pump CABG using the aortic nonclamping technique. Among the procedures, 354 were performed using pedicle arterial grafts alone, and 99 were done using a saphenous vein graft with a proximal anastomosis device. Nine were performed with aortic partial clamping for any reason. Postoperative cerebral complications, especially cerebral infarction, were analyzed.
  
  
  RESULTS
  Cerebral infarction occurred in two cases (0.47%) in the aortic nonclamping group. They were delayed in both cases, one occurring on the third day after operation and the other on the fourth day. One patient in the aortic clamping group had an intraoperative (early) cerebral infarction.
  
  
  CONCLUSIONS
  The aortic nonclamping technique might reduce the incidence of cerebral complications and produce ideal bypass grafts using arterial grafts and saphenous vein grafts with a proximal anastomosis device.
authors: Division of Cardiovascular Surgery, Shimada General Hospital, Higashi-cho, Choshi, Chiba, Japan. drosawa@yahoo.co.jp
authors: Hiroshi
authors: H
authors: Osawa
authors: Hirotaka
authors: H
authors: Inaba
authors: Osamu
authors: O
authors: Kinoshita
authors: Okihiko
authors: O
authors: Akashi
authors: Sachito
authors: S
authors: Minegishi
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000209:etiology / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D005260:Female; D024405:Gastroepiploic Artery / Q000637:transplantation*; D006801:Humans; D007564:Japan; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome