Coronary Disease

Off Pump Coronary Revascularization Reduces Incidence Of Stroke

George Pete Batsides, Mark B Anderson, Gary B Nackman, Manisha Shende, Alann Solina, Kelly Mabin, Tyrone James Krause
UMDNJ Robert Wood Johnson Medical School, New Brunswick, NJ, United States

Background: Stroke is a devastating complication associated with coronary bypass surgery. At our institution "Off Pump" coronary revascularization has become the technique of choice. This review was performed to test the hypothesis that OPCAB reduces the risk of postoperative stroke.

Methods: Single institution, retrospective study reviewing 460 consecutive CABGs (with / without cardioplegic arrest) and comparing these results with 460 consecutive OPCABs. Cases were performed between 3/03-6/04. Both groups included patients referred for only coronary revascularization.

Results: There was a reduction in postoperative stroke in the OPCAB group (0%; 0 of 466) compared to the CABG group (1.5%; 7 of 466), P=.015 by Fisher's Test. Logistic modeling identified those undergoing CABG and those with diabetes at increased risk for postoperative stroke. Postoperative mortality rate was reduced from 1.7% (8 of 466)in CABG group to 0.8% (4 of 466) in OPCAB group,however, this was not statistically significant (P=.26 by Fisher's Test). Acute renal failure was reduced by 50% in the OPCAB group from 6.8% (32 of 466 CABG) to 3.2% (15 of 466 OPCAB), P=.01 by Chi Square Test. Those undergoing CABG and those with PVD were at increased risk for ARF by Logistical Regression (Odds Ratio: 2.3, 2.7 respectively; P<.05). The incidence in postoperative bleeding requiring reexploration and postoperative blood product use between the two groups were similar.

Conclusions: Avoidance of cardiopulmonary bypass in OPCAB surgery may significantly reduce the incidence of stroke associated with coronary revacularizations. Our data reveals a signifcant reduction in clinically relevant neurological injury in our OPCAB population.