Further reduction in stroke after off-pump coronary artery bypass grafting: A 10-year experience

Background. Perioperative stroke is a devastating complication after corona ry artery bypass grafting (CABG). The reported incidence of neurologic comp lications after conventional CABG is 3% to 7%. With improved monitoring and surgical techniques, we have been able to achieve a drastic reduction in t he stroke rate in our institution. This study evaluates the incidence of ne urologic sequelae in patients who underwent off-pump CABG. Methods. Over a 10-year period from January 1990 to September 2000, off-pum p coronary artery bypass (OPCAB) operation was performed on 2,800 patients of the 18,037 patients undergoing CABG during that time frame at the Escort s Heart Institute and Research Centre. Initially, OPCAB was performed selec tively in the high-risk group of patients (atheromatous aorta, renal impair ment, chronic obstructive pulmonary disease, octogenarians, etc). Lately we performed multivessel OPCABs electively in about 60% to 65% of the patient s undergoing CABG. Results. Mean age of the patients was 58.0 +/- 9.91 years (range 27 to 85 y ears) and mean number of grafts was 2.9 per patient. Neurologic complicatio ns (stroke/transient ischemic attack) occurred in 0.14% of patients. Overal l hospital mortality in OPCAB patients was 2.14%, whereas mortality from ne urologic complications was 0.07%. Predicted mortality (National Society of Thoracic Surgeons Cardiac Surgery Database Risk Model for CABG) for the ent ire patient group was 3.86% (p < 0.001). Conclusions. Although current techniques of monitoring and surgical procedu res have significantly reduced the risk of stroke from CABG, our data stron gly support OPCAB as a technique to further reduce stroke after CABG, espec ially in the high-risk group of patients. (C) 2001 by The Society of Thorac ic Surgeons.