Post-Operative Stroke Risk in Coronary Artery Bypass Graft

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A meta-analysis of various CABG techniques assessed each for stroke risk, bleeding complications, atrial fibrillation, and mortality.
A meta-analysis of various CABG techniques assessed each for stroke risk, bleeding complications, atrial fibrillation, and mortality.

HealthDay News — Anaortic off-pump coronary artery bypass grafting (anOPCABG) is associated with reduced risk of postoperative stroke compared with other CABG techniques, according to a meta-analysis published in the Journal of the American College of Cardiology.

Dong Fang Zhao, from the University of Sydney, and colleagues conducted a network meta-analysis to compare postoperative outcomes between all CABG techniques. Data were included for 13 studies with 37,720 patients. Techniques included anOPCABG, off-pump with the clampless Heartstring device (OPCABG-HS), off-pump with a partial clamp (OPCABG-PC), and traditional on-pump CABG with aortic cross-clamping.

The researchers found that anOPCABG patients had higher previous stroke than OPCABG-PC and CABG patients (7.4% vs 6.5% and 3.2%, respectively) at baseline. The most effective treatment for decreasing the risk of postoperative stroke was anOPCABG (−78% vs CABG; −66% vs OPCABG-PC; and −52% vs OPCABG-HS). AnOPCABG was also most effective for reducing the risk of mortality (−50% vs CABG and −40% vs OPCABG-HS), renal failure (−53% vs CABG), bleeding complications (−48% vs OPCABG-HS and −36% vs CABG), and atrial fibrillation (−34% vs OPCABG-HS; −29% vs CABG; and −20% vs OPCABG-PC), and shortening the length of intensive care unit stay (−13.3 hours).

"Avoidance of aortic manipulation in anOPCABG may decrease the risk of postoperative stroke, especially in patients with higher stroke risk," the authors write.

References

  1. Zhao DF, Edelman JJ, Seco M, et al. Coronary artery bypass grafting with and without manipulation of the ascending aorta. J Am Coll Cardiol. 2017;69(8):924-936. doi: 10.1016/j..jacc.2016.11.071
  2. Bryrne JG, Leacche M. Off-pump CABG surgery "no-touch" technique to reduce adverse neurological outcomes. J Am Coll Cardiol. 2017;69(8):937-938. doi: 10.1016/j.jacc.2016.12.015
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