title: Improve morbidity and mortality in coronary artery bypass graft surgery for severe atherosclerosis.
abstract: OBJECTIVE
  Atherosclerosis has been identified as a risk factor for both morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG). To investigate outcomes following CABG for severe atherosclerosis, and to determine whether different surgical techniques can reduce the risk of neurologic events in these patients.
  
  
  METHODS
  We studied 225 consecutive patients who underwent elective isolated CABG. Routine preoperative and intraoperative examinations identified patients with severe atherosclerosis. We compared the outcomes between patients with (group A; 42 ceses) and those without (group N; 183 cases) severe atherosclerosis.
  
  
  RESULTS
  36 patients (85.7%) in group A and 176 (96.2%) in group N underwent off-pump coronary artery bypass (OPCAB); 6 (14.3%) in group A and 7 (3.8%) in group N underwent on-pump beating CABG. Three patients in group A suffered deep sternal infection (7.1%), and one suffered stroke (2.4%) compared with none in group N. No cerebral infarction or neurologic events occurred in patients who underwent OPCAB (n = 212, 94.2%).
  
  
  CONCLUSIONS
  Prevalence of complications was significantly greater among patients with severe atherosclerotic disease who underwent OPCAB than in those without atherosclerotic disease. Careful selection of surgical strategies can prevent perioperative stroke and reduce mortality.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan ; Division of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kanemitsu
authors.forename: Sawaka
authors.initials: S
authors.lastname: Tanabe
authors.forename: Kensuke
authors.initials: K
authors.lastname: Ohue
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Miyagawa
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Manabu
authors.initials: M
authors.lastname: Okabe
keywords: atherosclerosis; complications; coronary artery bypass graft; off-pump coronary artery bypass; stroke
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