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 journalArticleAcademicpeer-review

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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


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 languageEnglish
Article number013650
Number of pages11
JournalJournal of the American Heart Association
Issue number24
Publication statusPublished - 17 Dec 2019


  • aortic clamp
  • coronary artery bypass grafting
  • off-pump
  • on-pump
  • stroke
  • PUMP
  • RISK

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