STROKE AFTER CORONARY ARTERY BYPASS SURGERY WITH AND WITHOUT CARDIOPULMONARY BYPASS

Authors

  • Javed Iqbal
  • Abdul Ghaffar
  • Ahmad Shahbaz
  • Abdul Rehman Abid

Abstract

Background: Stroke is a devastating complication of coronary artery bypass grafting (CABG). This study was carried out with the aim that the development of off pump coronary artery surgery decreases the incidence/adverse outcome due to extra corporeal circulation. Methods: The data utilized in this study was extracted from a randomized controlled trial that was conducted from January 2006 to March 2007 at Punjab Institute of Cardiology. One hundred patients were included in ‘on pump’ group-A, and 100 patients in ‘off pump’ group-B. Results: The mean age of the patients in group-A was 53.51±9.96 years and in group-B it was 51.59±10.30 years. Renal failure occurred in 21% patients of group-A as compared to 10% of group-B while Acute Myocardial Infarction occurred in significantly higher number of patients in group-B (11%) as compared to group-A (2%). Off pump was associated with significant decrease in rate of stroke 1.5% as compared to on pump 3.5%. similarly there was decreased in the risk of deaths after stroke 0% as compared to on pump 1.5% mortality after stroke. In group A 6(3.5%) patients developed stroke where as in group-B 2(1.5%) patients developed stroke out of these 6 patients there were 2 mortalities after stroke in group-A while in group-B there was no mortality after stroke within 30 days postoperatively. Conclusion: Off pump CABG is associated with significantly decreased rate of stroke in comparison with the on-pump CABG.Keyword: Coronary artery bypass grafting, Cardiopulmonary bypass, cerebrovascular accident, stroke

References

Diegeler A, Hirsch R, Schneider F, Schilling LO, Falk V, Rauch C, et al. Neuromonitoring and neurocognitive outcome in off pump versus conventional coronary bypass operation. Ann Thorac Surg 2000;69:1162–6.

Lund C, Hol PK, Lundblad R, Fosse E, Sundet K, TennoeB, et al. Comparison of cerebral embolization during off pump and on pump coronary artery bypass surgery. Ann Thorac Surg 2003;76:765–770.

Lee JD, Lee SJ, Tsushima WT, Yamauchi H, Lau WT, Popper J, et al. Benefits of off pump bypass on neurologic and clinical morbidity: a prospective randomized trial. Ann Thorac Surg 2003;76:18–25.

McKhann GM, Grega MA, Borowicz LM Jr, Baumgarter WA, Selnes OA. Stroke and encephalopathy after cardiac surgery: an update. Stroke 2006:37:562–71.

Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Economic outcome of off pump coronary artery bypass surgery; a prospective randomized study. Ann Thorac Surg 1999;68:2237–42.

Demaria RG, Carrier M, Fortier S, Martineau R, Fortier A, Cartier R, et al. Reduced mortality and strokes with off pump coronary artery bypass grafting surgery in octogenarians. Circulation 2002;106(12 Suppl 1):5–10.

van der Linden J, Hadjinikolaou L, BergmanP, Lindblom D. Postoperative stroke in cardiac surgery is related to the location and extent of atherosclerotic disease in the ascending aorta. J Am Coll Cardiol 2001;38:131–5.

Ascione R, Reeves BC, Chamberlain MH, Ghosh AK, Lim KH, Angelini GD. Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study. Ann Thorac Surg 2002;74:474–80.

Almassi GH, Sommers T, Moritz TE, Shroyer AL, London MJ, Henderson WG, et al. Stroke in cardiac surgical patients: determinants and outcome. Ann Thorac Surg 1999;68:391–7.

Hogue CW, Murphy SF, Schechtman KB, Davila-Roman VG. Risk factors for early or delayed stroke after cardiac surgery. Circulation 1999;100:642–7.

Sedrakyan A, Wu AW, Parashar A, Bass EB, Treasure T. Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery grafting: a meta analysis of systematically reviewed trials. Stroke 2006;37:2759–69.

Filsoufi F, Rahmanian PB, Castillo JG, Bronster D, Adams DH. Incidence, topography, predictors and long term survival after stroke in patients undergoing coronary artery bypass grafting. Ann Thorac Surg 2008;85:862–70.

Van der Linden J, Bergaman P, Hadjinikolaou L. The topography of the aortic atherosclerosis enhances its precision as a predictor of stroke. Ann Thorac Surg 2007;83:2087–92.

McKhann GM, Grega MA, Borowicz LM, Baumgarter WA, Selnes OA, Stroke and encephalopathy after cardiac surgery:an update. Stroke 2006;37:562–71.

Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L, et al. The impact of epiaortic ultrasonogrphy scanning on the risk of perioperative stroke. Eur J Cardiothorac Surg 2006;29:720–8.

Zamvar V, William D, Hall J, Payne N, Cann C, Young K, et al. Assessment of neurocognitive impairment after off pump and on pump techniques for coronary artery bypass graft surgery: a prospective randomized controlled trial. BMJ 2002;325:1268.

Frye RL, Kronmal R, Schaff HV, Myers WO, Gersh BJ. Stroke in coronary artery bypass graft surgery: an analysis of the CASS experience. The participants in the coronary artery surgery study. Int J Cardiol 1992;36:213–21.

Likosky DS, Leavitt BJ, Marrin CA, Malenka DJ, Reeves AG, Weintraub RM, et al. Intra and postoperative predictors of stroke after coronary artery bypass grafting. Ann Thorac Surg 2003;76:428–34.

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Published

2014-06-01

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