Abstract
ObjectivesStroke is a devastating complication after coronary artery bypass grafting, occurring in 1.4% to 4.3% of patients. A major cause of stroke is cerebral embolization of aortic atheromatous debris or calcified plaques. This report analyzes the incidence of stroke in patients treated according to the clampless concept, i.e. avoiding side-clamping of the aorta, by means of off-pump coronary artery bypass surgery (OPCAB) in combination with the HEARTSTRING device.MethodsDuring a period of 43 months (2005-2008), 412 consecutive patients were treated with the above-mentioned method by one single surgeon. A minimum of one proximal aortal anastomosis was performed in each patient. Altogether, 542 proximal anastomosis were applied, each created by means of the HEARTSTRING device.ResultsThe mean age of patients was 67+9.7 years, the predicted mortality 5.2% (logistic EuroSCORE) and the observed mortality 1.9%. Histories of preoperative neurological disorders or cerebrovascular diseases were documented in 15% of patients. The overall incidence of postoperative stroke was 0.48% in contrast to 1.3% according to the stroke risk score.ConclusionsIn accordance to previously published data, our results show that avoiding aortic side-clamping during OPCAB reduces postoperative stroke rates. The HEARTSTRING device is a safe option for creating proximal aortic anastomosis.
Highlights
Cardiac surgery is increasingly conducted in elderly patients with extensive comorbidities
Study population From 2005 to 2008 (43 months), 412 consecutive patients undergoing off-pump coronary artery bypass grafting (CABG) with a minimum of one proximal aortal anastomosis were prospectively enrolled into our analysis
The major outcome variable of this study was the occurrence of postoperative stroke. This complication was defined in accordance with the definition of stroke previously published by the Northern New England Cardiovascular Disease Study Group (NNECDSG)
Summary
Cardiac surgery is increasingly conducted in elderly patients with extensive comorbidities. Perioperative stroke is still one of the most devastating complications of coronary bypass surgery that causes high patient morbidity and mortality and excessive economic costs [1,2,3]. Tic embolism because of the tangential clamping maneuver during the construction of proximal anastomosis [79]. To overcome this problem, we routinely conducted HEARTSTRING supported proximal anastomosis during OPCAB procedures following the clampless principle. Several authors have reported their first clinical experiences with the HEARTSTRING system [10,11,12,13]; our observations of 412 consecutive patients (542 proximal anastomosis) were made with particular regard to stroke rates
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