title: Medium-term neurological complications after off-pump coronary artery bypass grafting with and without aortic manipulation.
abstract: BACKGROUND
  This study aimed to assess the impact of aortic manipulation during off-pump coronary artery bypass (OPCAB) on neurological complications.
  
  
  RESULTS
  Of 336 isolated OPCAB surgeries, the aorta was untouched in 264 cases (group A), whereas it was manipulated by a side-biting clamp in 72 (group B). The average follow-up was 2.9±2.5 years. One patient in each group developed postoperative stroke (P=0.38). The prevalence of triple-vessel disease (group A 40.9% vs. group B 61.1%; P=0.0003) and left main trunk disease (group A 30.7% vs. group B 47.2%; P=0.1) was lower in group A than in group B. The number of bypass grafts (group A 2.18±0.97 vs. group B 3.00±0.97; P=0.0001) was lower in group A than in group B. The prevalence of preoperative atrial fibrillation and the incidence of new-onset postoperative atrial fibrillation were not different between groups (P=0.74 and 0.86, respectively). Survival rate and freedom from major adverse cardiac events were not different between groups (P=0.87 and 0.51, respectively). However, freedom from neurological complications was significantly lower in group A (P=0.0006). The Cox hazard model showed that aortic manipulation (P=0.004; odds ratio, 6.18; 95% confidence interval, 1.8-21.6) and preoperative atrial fibrillation (P=0.001; odds ratio, 14.0; 95% confidence interval, 2.7-72.5) were risk factors for neurological complications.
  
  
  CONCLUSIONS
  Although there was no difference in the incidence of immediate postoperative neurological complications, there were fewer medium-term neurological complications in OPCAB cases without aortic manipulation.
authors.affiliation: Department of Cardiovascular Surgery, Funabashi Municipal Medical Center, Chiba, Japan. km4717jp@yahoo.co.jp
authors.forename: Kaoru
authors.initials: K
authors.lastname: Matsuura
authors.forename: Kenji
authors.initials: K
authors.lastname: Mogi
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakurai
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kawamura
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Takahara
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001011:Aorta / Q000601:surgery*; D001281:Atrial Fibrillation / Q000401:mortality; D016009:Chi-Square Distribution; D003250:Constriction; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality