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Incidence of perioperative stroke in clampless aortic anastomosis during off-pump coronary artery bypass grafting

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Abstract

This study aimed to assess if clampless off-pump coronary artery bypass grafting (OPCAB) decreases the incidence of perioperative stroke (POS) rate and in-hospital mortality. The secondary aim was to evaluate 12-year rates of overall mortality. Between January 2003 to December 2015, data of 645 consecutive patients undergoing isolated CABG were retrospectively collected. 363 underwent aortic no-touch OPCAB (No-touch group) and 282 underwent OPCAB with the Heartstring device (HS group). In-hospital mortality and perioperative stroke rate as primary endpoint, as well as long-term follow-up outcome were analysed. In-hospital mortality was lower into No-touch group compared with HS group but without significant statistical difference (1.7 vs. 3.2%, p = 0.19, respectively); the rate of postoperative stroke was higher in No-touch group compared with HS group, although this difference did not reach statistically significance. Delirium was reported with higher presentation rate in HS group (3.9 vs. 0.8%, p = 0.01). Blood transfusions rate was higher in HS subjects (23.4 vs. 16.1%, p = 0.01). Intubation time, ICU, and hospital length of stay were increased in the HS group (p = 0.008, p = 0.001 and p = 0.003, respectively). Over a 12-year follow-up period, survival probabilities at 1, 5, and 10 years were 93.6 ± 1.3 vs. 93.2 ± 1.5, 80.4 ± 2.6 vs. 80.3 ± 2.2, and 57.9 ± 5 vs. 58.4 ± 3.8% in the No-touch and HS group, respectively (p = 0.97). In this retrospective study, clampless off-pump CABG lowers perioperative stroke rate whose incidence is, however, not inferior compared with No-touch technique, and no statistically significance was detected. Delirium has a higher presentation rate in clampless off-pump CABG.

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Acknowledgements

The authors wish to thank Giorgia Pavan for her precious English editing contribution.

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Authors and Affiliations

  1. Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Via G.B. Pergolesi 33, 20052, Monza, MB, Italy

    Francesco Formica, Stefano D’Alessandro & Giovanni Paolini

  2. Department of Critical Care Medicine and Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada

    Gurmeet Singh

  3. Statistics and Quality Health Service, San Gerardo Hospital, Monza, Italy

    Luigi Amerigo Messina

  4. Department of Anaesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy

    Fabio Sangalli

  5. Cardiac Surgery Unit, Niguarda Hospital, Milano, Italy

    Giuseppe Tata

  6. Cardiac Surgery Unit, Twente Thorax Center, Enschede, The Netherlands

    Serena Mariani

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  1. Francesco Formica
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  2. Giuseppe Tata
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  3. Gurmeet Singh
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  4. Serena Mariani
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  6. Luigi Amerigo Messina
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  8. Giovanni Paolini
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Correspondence to Francesco Formica.

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Formica, F., Tata, G., Singh, G. et al. Incidence of perioperative stroke in clampless aortic anastomosis during off-pump coronary artery bypass grafting. Heart Vessels 33, 595–604 (2018). https://doi.org/10.1007/s00380-017-1106-0

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  • DOI: https://doi.org/10.1007/s00380-017-1106-0

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