Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization

Calafiore, Antonio M.; Mauro, Michele Di; Teodori, Giovanni; Giammarco, Gabriele Di; Cirmeni, Sergio; Contini, Marco; Iacò, Angela L.; Pano, Marco

doi:10.1016/s0003-4975(02)03470-7

Cited by 170 publications

(116 citation statements)

References 30 publications

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“…15) Calafiore et al note that limited or no manipulation of the ascending aorta in patients with severe atheromatous aortic disease is important. 16) We found that avoiding CPB and manipulation of the aorta improved outcomes in this subset of high-risk patients.…”

Section: Discussionmentioning

confidence: 69%

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Kanemitsu

Tanabe

Ohue

et al. 2011

Annals of Vascular Diseases

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Objectives: Atherosclerosis has been identified as a risk factor for both morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG). To investigate outcomes following CABG for severe atherosclerosis, and to determine whether different surgical techniques can reduce the risk of neurologic events in these patients. Methods: We studied 225 consecutive patients who underwent elective isolated CABG. Routine preoperative and intraoperative examinations identified patients with severe atherosclerosis. We compared the outcomes between patients with (group A; 42 ceses) and those without (group N; 183 cases) severe atherosclerosis. Results: 36 patients (85.7%) in group A and 176 (96.2%) in group N underwent off-pump coronary artery bypass (OPCAB); 6 (14.3%) in group A and 7 (3.8%) in group N underwent on-pump beating CABG. Three patients in group A suffered deep sternal infection (7.1%), and one suffered stroke (2.4%) compared with none in group N. No cerebral infarction or neurologic events occurred in patients who underwent OPCAB (n = 212, 94.2%). Conclusions: Prevalence of complications was significantly greater among patients with severe atherosclerotic disease who underwent OPCAB than in those without atherosclerotic disease. Careful selection of surgical strategies can prevent perioperative stroke and reduce mortality.

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Section: Discussionmentioning

confidence: 69%

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Kanemitsu

Tanabe

Ohue

et al. 2011

Annals of Vascular Diseases

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“…This should reduce the incidence of embolic events from the atheromatous aorta. [4][5][6] The glial protein S100 has recently been shown to be an early marker of brain injury after cardiac surgery, and the majority of S100 studies have been related to cardiac surgery and CPB.…”

Section: Discussionmentioning

confidence: 99%

Effect of Different Anesthetic Techniques on Mental Outcome in Elderly Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

Özer¹,

Yilmaz²

2017

Turkiye Klinikleri J Cardiovasc Sci

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : In this article, we aimed to test the hypothesis that maintenance of hemodynamic stability with anesthesia and no-touch aortic technique in off-pump coronary artery bypass graft surgery (CABG) may diminish postoperative mental complications in elderly patients. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Between June 2009 and December 2009, 88 elderly patients (53 males, 35 females; mean age 71±7 years; range 64 to 78 years) with a physical status of ASA II-III who underwent elective off-pump CABG surgery in our hospital's operating rooms and cardiovascular and thoracic intensive care units were included in this prospective randomized study with signed informed consents. Patients undergoing off-pump CABG surgery performed by a surgeon were randomly assigned into two groups, including total intravenous anesthesia (group TIVA, n=40; mean age 66±4) or inhalational anesthesia (group IA, n=40; mean age 69±3). The effect of off-pump CABG surgery on mental outcome was assessed with S100 protein, a neurochemical marker of brain injury under ischemic conditions. Comparison of mental function before and after off-pump CABG surgery, hemodynamic stability and time to discharge were the main outcomes of the study. R Re es su ul lt ts s: : Hemodynamic values were stable in both groups. None of the patients showed marked increase in serum concentrations of S100 postoperatively (p<0.001). The mean total off-pump CABG time was 48±15 minutes in both groups. There was no difference between the groups in terms of time to discharge. C Co on nc cl lu us si io on n: : We believe that well-performed hemodynamic stability with either intravenous or general anesthesia may offer a well-controlled mental function in elderly patients undergoing offpump CABG surgery. K Ke ey yw wo or rd ds s: : Coronary artery bypass, off-pump; coronary artery bypass; anesthetics, inhalation; anesthetics, intravenous Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada, atan kalpteki koroner arter baypas greft (KABG) cerrahisinde hemodinamik stabilitenin anestezi, iyi premedikasyon ve dokunmasız aort tekniğiyle sağlanmasının yaşlı-larda ameliyat sonrası zihinsel komplikasyonları azaltabileceği hipotezi test edildi. G Ge er re eç ç v ve e Y Yö ön n--t te em ml le er r: : Haziran-Aralık 2009 tarihleri arasında, hastanemizin ameliyathaneleri ve kardiyovasküler ve torasik yoğun bakım ünitelerinde elektif olarak atan kalpte KABG cerrahisi geçiren ve fiziksel durumu ASA II-III olan 88 yaşlı hasta (53 erkek, 35 kadın; ortalama yaş 71± 7yıl; dağılım aralığı 64 ile 78 yıl) bilgilendirilmiş onam alınarak bu prospektif ve randomize çalışmaya dahil edildi. Tek cerrah tarafından yürütülen atan kalpte KABG cerrahisi geçiren hastalar total intravenöz anestezi (grup TIVA, n=40; ortalama yaş 66±4) veya inhalasyon anestezisi (grup IA, n=40; ortalama yaş 69±3) olmak üzere iki gruba ayrıldı. Atan kalpte KABG cerrahisinin beyindeki sonuçları iskemik durumlarda nörokimyasal belirteç olan S100 proteini ile değerlendiril...

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“…One advantage of OPCAB is the avoidance of aortic cannulation and CPB which is intuitively attractive for its potential stroke reduction (24,25). In addition, OPCAB uniquely offers the possibility of routinely minimizing or even completely avoiding aortic manipulation, by use of clampless facilitating devices [e.g., HEARTSTRING III (Maquet, Rastatt, Germany)] or utilizing only internal thoracic arterial inflows without aortocoronary anastomoses to further reduce the risk of stroke to levels similar to those reported with multivessel PCI (25)(26)(27).…”

Section: Overview Of the Opcab Randomized Controlled Trial (Rct) Litementioning

confidence: 99%

The future of off-pump coronary artery bypass grafting: a North American perspective

2016

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Off-pump coronary artery bypass graft (OPCAB) is currently performed routinely in a minority of specialized centers and in many more centers, utilized only when a porcelain aorta mandates a no-touch aortic technique. The OPCAB literature can be summarized as follows: (I) large-scale randomized trials in relatively low risk patients that include surgeons with a range of experience demonstrating no consistent beneficial differences in major cardiovascular and cerebrovascular outcomes but lower transfusion rates and shorter length of stay, tempered by some reports of higher rates of incomplete revascularization and lower rates of long term graft patency; (II) smaller randomized controlled trials (RCTs) from highly specialized programs demonstrating equivalent or superior outcomes with OPCAB and similar completeness of revascularization and graft patency; and (III) observational data from large databases demonstrating a consistent benefit of OPCAB, especially in higher-risk patient subsets. Our rationale for OPCAB remains that if complete and precise revascularization can be safely and routinely accomplished, then the patient should benefit by avoiding the morbidities that can be attributed to aortic cannulation/clamping, cardiopulmonary bypass (CPB), hemodilution, hypothermia and global myocardial ischemia/cardioplegia.We further believe that OPCAB procedures should emphasize the use of arterial grafts to optimize long term patency and minimize aortic manipulation to limit the risk of stroke. Moving forward, the off-pump surgical community and specialty societies must address the challenge of training surgeons and their teams to master this technically demanding procedure. Furthermore, OPCAB opens the door to minimally-invasive surgical revascularization via hybrid coronary revascularization (HCR). A large NIH-funded RCT is currently underway to determine whether hybrid revascularization can offer a superior alternative to multi-vessel percutaneous coronary intervention for patients with low SYNTAX score and proximal LAD disease.

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Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization

Cited by 170 publications

References 30 publications

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Effect of Different Anesthetic Techniques on Mental Outcome in Elderly Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

The future of off-pump coronary artery bypass grafting: a North American perspective

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