title: "Beyond beating heart surgery": heartstring device protects against perioperative neurological events.
abstract: OBJECTIVE
  : There is a growing body of evidence favoring off-pump coronary artery bypass surgery (OPCAB) over traditional coronary artery bypass surgery (CABG) with cardiopulmonary bypass as a method for reducing perioperative neurologic events. Aortic manipulation, whether with OPCAB or coronary artery bypass surgery with cardiopulmonary bypass, is strongly linked with adverse neurologic outcomes. Although the aortic "no-touch" technique has merit, most cardiac surgeons are reluctant to base entire myocardial revascularization exclusively on mammary pedicles. The purpose of this study was to analyze our experience with OPCAB combined with the use of a Heartstring proximal anastomotic device, as a strategy for reducing clinically evident cerebrovascular accidents.
  
  
  METHODS
  : Two hundred twenty-seven consecutive isolated OPCAB were performed without the use of a side-biting aortic clamp. In all these operations, a Heartstring device was used, permitting clampless hand-sutured proximal anastomoses. All patients were managed in this fashion regardless of the status of their ascending aorta. A mean of 3.4 bypasses were performed during each operation, with one or two mammary arteries harvested routinely. In 98% of patients, a single proximal anastomosis was performed; there was liberal use of sequential bypass grafts.
  
  
  RESULTS
  : Mean age was 69.3 years, with 17% octogenarians. Preexisting cerebrovascular disease was present in 22.4% of patients. There were no clinically evident perioperative neurologic events in any patients. There were no operative deaths.
  
  
  CONCLUSIONS
  : This series suggests that OPCAB performed with a single, clampless, proximal aortic anastomosis, and with a Heartstring device may protect against perioperative strokes.
authors.affiliation: From the Division of CardioThoracic & EndoVascular Surgery, St. Helena Hospital Cardiovascular Center, St. Helena, Napa Valley, CA USA.
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Sakopoulos
authors.forename: John G
authors.initials: JG
authors.lastname: Jacobson
authors.forename: Don R
authors.initials: DR
authors.lastname: Wilson
authors.forename: Wilfred M
authors.initials: WM
authors.lastname: Huse