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Stroke Rate of Off-pump Coronary Artery Bypass; Aortocoronary Bypass Versus in-Situ Bypass

Department of Cardiovascular Surgery, Kobari General Hospital, Chiba, Japan (Dr. Hirose recently moved to the Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH).

Atushi Amano, MD

Cardiovascular Center, Showa University, Yokohama City Northern Hospital, Japan.

Off-pump coronary artery bypass (OPCAB) using in-situ grafts does not require aortic manip ulation, and it is theoretically free from the risk of stroke. Because of the limited availability of in-situ grafts, aortocoronary bypass has been conducted in addition to in-situ grafting. In this paper, the authors prospectively investigated whether or not on aortocoronary bypass increases the incidence of stroke after off-pump bypass. Perioperative data were collected prospectively from patients who underwent isolated off-pump bypass at their hospital group between March 1997 and February 2002. The patients were divided into 2 groups; group AC (patients with at least 1 aortocoronary bypass, n = 280) and group IS (patients with all in-situ grafts, n = 234). Patients with 3-vessel disease more frequently underwent aortocoronary bypass and patients with a history of stroke, calcified ascending aorta, or renal failure more often underwent in-situ graft. The number of distal anastomoses was greater in group AC (3.5 ± 1.0) than in group IS (2.7 ± 1.1), p < 0.0001. Patient recovery and complication rates were similar, including the occurrence of postoperative stroke: 3.0% (7/234) in group IS vs 0.7% (2/280) in group AC, p=0.051, NS. The graft patency and remote results were not significantly different between the 2 groups. Side clamping of the aorta used in off-pump aortocoronary bypass does not increase the risk of postoperative strokes compared to in-situ bypass. Postoperative stroke after OPCAB may depend on the patient's preoperative comorbidities.

Angiology, Vol. 54, No. 6, 647-653 (2003)
DOI: 10.1177/000331970305400603


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