Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke

Roberto Lorusso; Marco Moscarelli; Antonino Di Franco; Valentina Grazioli; Francesco Nicolini; Tiziano Gherli; Michele De Bonis; Maurizio Taramasso; Emmanuel Villa; Giovanni Troise; Roberto Scrofani; Carlo Antona; Giovanni Mariscalco; Cesare Beghi; Antonio Miceli; Mattia Glauber; Marco Ranucci; Carlo De Vincentiis; Mario Gaudino

doi:10.1161/JAHA.119.013650

Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke

Roberto Lorusso^*, Marco Moscarelli, Antonino Di Franco, Valentina Grazioli, Francesco Nicolini, Tiziano Gherli, Michele De Bonis, Maurizio Taramasso, Emmanuel Villa, Giovanni Troise, Roberto Scrofani, Carlo Antona, Giovanni Mariscalco, Cesare Beghi, Antonio Miceli, Mattia Glauber, Marco Ranucci, Carlo De Vincentiis, Mario Gaudino

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background

The impact of the coronary artery bypass grafting (CABG) technique (on- versus off-pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series.

Methods and Results

A retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on-pump CABG (ONCAB) or off-pump CABG (OPCAB) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on-pump versus off-pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propensity matching were used. ONCAB procedures were performed in 17 231 cases and OPCAB in 8157. The incidence of postoperative stroke was significantly lower in the OPCAB group even after propensity matching (0.4% OPCAB versus 1.2% ONCAB, P=0.02). In the ONCAB group (but not in the OPCAB arm) the use of single aortic clamping was associated with significantly reduced postoperative stroke rate (odds ratio, 0.05; 95% CI, 0.008 to 0.07 [P

Conclusions

OPCAB and the use of single aortic clamping in the ONCAB arm were associated with a reduced incidence of postoperative stroke. Our data confirm a strong association between aortic manipulation and neurological outcome after CABG surgery.

Original language	English
Article number	013650
Number of pages	11
Journal	Journal of the American Heart Association
Volume	8
Issue number	24
DOIs	https://doi.org/10.1161/JAHA.119.013650
Publication status	Published - 17 Dec 2019

Keywords

aortic clamp
coronary artery bypass grafting
off-pump
on-pump
stroke
AORTIC MANIPULATION
PUMP
SURGERY
RISK
METAANALYSIS
PREDICTOR
MORBIDITY
OUTCOMES
CLAMP

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Cite this

Lorusso, R., Moscarelli, M., Di Franco, A., Grazioli, V., Nicolini, F., Gherli, T., De Bonis, M., Taramasso, M., Villa, E., Troise, G., Scrofani, R., Antona, C., Mariscalco, G., Beghi, C., Miceli, A., Glauber, M., Ranucci, M., De Vincentiis, C., & Gaudino, M. (2019). Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke. Journal of the American Heart Association, 8(24), Article 013650. https://doi.org/10.1161/JAHA.119.013650

@article{76c283b65d5a44b69e279975d40ecb5b,

title = "Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke",

abstract = "BackgroundThe impact of the coronary artery bypass grafting (CABG) technique (on- versus off-pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series.Methods and ResultsA retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on-pump CABG (ONCAB) or off-pump CABG (OPCAB) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on-pump versus off-pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propensity matching were used. ONCAB procedures were performed in 17 231 cases and OPCAB in 8157. The incidence of postoperative stroke was significantly lower in the OPCAB group even after propensity matching (0.4% OPCAB versus 1.2% ONCAB, P=0.02). In the ONCAB group (but not in the OPCAB arm) the use of single aortic clamping was associated with significantly reduced postoperative stroke rate (odds ratio, 0.05; 95% CI, 0.008 to 0.07 [PConclusionsOPCAB and the use of single aortic clamping in the ONCAB arm were associated with a reduced incidence of postoperative stroke. Our data confirm a strong association between aortic manipulation and neurological outcome after CABG surgery.",

keywords = "aortic clamp, coronary artery bypass grafting, off-pump, on-pump, stroke, AORTIC MANIPULATION, PUMP, SURGERY, RISK, METAANALYSIS, PREDICTOR, MORBIDITY, OUTCOMES, CLAMP",

author = "Roberto Lorusso and Marco Moscarelli and {Di Franco}, Antonino and Valentina Grazioli and Francesco Nicolini and Tiziano Gherli and {De Bonis}, Michele and Maurizio Taramasso and Emmanuel Villa and Giovanni Troise and Roberto Scrofani and Carlo Antona and Giovanni Mariscalco and Cesare Beghi and Antonio Miceli and Mattia Glauber and Marco Ranucci and {De Vincentiis}, Carlo and Mario Gaudino",

note = "Publisher Copyright: {\textcopyright} 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",

year = "2019",

month = dec,

day = "17",

doi = "10.1161/JAHA.119.013650",

language = "English",

volume = "8",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley",

number = "24",

}

Lorusso, R, Moscarelli, M, Di Franco, A, Grazioli, V, Nicolini, F, Gherli, T, De Bonis, M, Taramasso, M, Villa, E, Troise, G, Scrofani, R, Antona, C, Mariscalco, G, Beghi, C, Miceli, A, Glauber, M, Ranucci, M, De Vincentiis, C & Gaudino, M 2019, 'Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke', Journal of the American Heart Association, vol. 8, no. 24, 013650. https://doi.org/10.1161/JAHA.119.013650

TY - JOUR

T1 - Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke

AU - Lorusso, Roberto

AU - Moscarelli, Marco

AU - Di Franco, Antonino

AU - Grazioli, Valentina

AU - Nicolini, Francesco

AU - Gherli, Tiziano

AU - De Bonis, Michele

AU - Taramasso, Maurizio

AU - Villa, Emmanuel

AU - Troise, Giovanni

AU - Scrofani, Roberto

AU - Antona, Carlo

AU - Mariscalco, Giovanni

AU - Beghi, Cesare

AU - Miceli, Antonio

AU - Glauber, Mattia

AU - Ranucci, Marco

AU - De Vincentiis, Carlo

AU - Gaudino, Mario

PY - 2019/12/17

Y1 - 2019/12/17

N2 - BackgroundThe impact of the coronary artery bypass grafting (CABG) technique (on- versus off-pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series.Methods and ResultsA retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on-pump CABG (ONCAB) or off-pump CABG (OPCAB) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on-pump versus off-pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propensity matching were used. ONCAB procedures were performed in 17 231 cases and OPCAB in 8157. The incidence of postoperative stroke was significantly lower in the OPCAB group even after propensity matching (0.4% OPCAB versus 1.2% ONCAB, P=0.02). In the ONCAB group (but not in the OPCAB arm) the use of single aortic clamping was associated with significantly reduced postoperative stroke rate (odds ratio, 0.05; 95% CI, 0.008 to 0.07 [PConclusionsOPCAB and the use of single aortic clamping in the ONCAB arm were associated with a reduced incidence of postoperative stroke. Our data confirm a strong association between aortic manipulation and neurological outcome after CABG surgery.

AB - BackgroundThe impact of the coronary artery bypass grafting (CABG) technique (on- versus off-pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series.Methods and ResultsA retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on-pump CABG (ONCAB) or off-pump CABG (OPCAB) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on-pump versus off-pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propensity matching were used. ONCAB procedures were performed in 17 231 cases and OPCAB in 8157. The incidence of postoperative stroke was significantly lower in the OPCAB group even after propensity matching (0.4% OPCAB versus 1.2% ONCAB, P=0.02). In the ONCAB group (but not in the OPCAB arm) the use of single aortic clamping was associated with significantly reduced postoperative stroke rate (odds ratio, 0.05; 95% CI, 0.008 to 0.07 [PConclusionsOPCAB and the use of single aortic clamping in the ONCAB arm were associated with a reduced incidence of postoperative stroke. Our data confirm a strong association between aortic manipulation and neurological outcome after CABG surgery.

KW - aortic clamp

KW - coronary artery bypass grafting

KW - off-pump

KW - on-pump

KW - stroke

KW - AORTIC MANIPULATION

KW - PUMP

KW - SURGERY

KW - RISK

KW - METAANALYSIS

KW - PREDICTOR

KW - MORBIDITY

KW - OUTCOMES

KW - CLAMP

U2 - 10.1161/JAHA.119.013650

DO - 10.1161/JAHA.119.013650

M3 - Article

C2 - 31830873

SN - 2047-9980

VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 24

M1 - 013650

ER -