Post-Operative Stroke Risk in Coronary Artery Bypass Graft
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.
- 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
- 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