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Sotiris C. Stamou
Albert J. Pfister
Peter C. Hill
Mercedes K.C. Dullum
Ammar S. Bafi
Steven W. Boyce
Kathleen R. Petro
Paul J. Corso
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Right arrow Minimally invasive surgery

Ann Thorac Surg 2002;74:394-399
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Stroke after conventional versus minimally invasive coronary artery bypass

Sotiris C. Stamou, MD, PhDa, Kathleen A. Jablonski, PhDb, Albert J. Pfister, MDa, Peter C. Hill, MDa, Mercedes K.C. Dullum, MDa, Ammar S. Bafi, MDa, Steven W. Boyce, MDa, Kathleen R. Petro, MDa, Paul J. Corso, MDa*

a Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, Washington, DC, USA
b MedStar Research Institute, Washington, DC, USA

Accepted for publication March 18, 2002.

* Address reprint requests to Dr Corso, Chief Section of Cardiac Surgery, Washington Hospital Center, 106 Irving Street NW, Suite 316, South Tower, Washington, DC 20010, USA
e-mail: paul.j.corso{at}medstar.net

Background. Postoperative stroke is a serious complication after coronary artery bypass grafting with cardiopulmonary bypass (on-pump), and portends higher morbidity and mortality. It is unknown whether an off-pump cardiopulmonary bypass (OPCAB) approach may yield a lower stroke rate over conventional on-pump coronary artery bypass grafting.

Methods. From June 1994 to December 2000, OPCAB was performed in 2,320 patients and compared with 8,069 patients who had on-pump coronary artery bypass grafting, during the same period of time. The patients undergoing OPCAB were randomly matched to on-pump patients by propensity score. A logistic regression model was used to test the difference in the postoperative stroke rate between OPCAB and on-pump procedures controlling for the correlation between matched sets. A multiple logistic regression model predicting the risk of stroke adjusted by stroke risk factors and operation type was also computed.

Results. Matches by propensity score were found for 72% of the patients undergoing OPCAB. Patients undergoing on-pump coronary artery bypass grafting were 1.8 (95% confidence interval 1.0 to 3.1, p = 0.03) times more likely to suffer a stroke postoperatively than OPCAB patients after controlling for preoperative risk factors through matching. Independent predictors of stroke identified from the multiple logistic model included on-pump operation (versus OPCAB operation), female gender, 4 to 6 vessels grafted (versus <4 grafts), hypertension, history of previous cerebrovascular accident, carotid artery disease, chronic obstructive pulmonary disease, and depressed ejection fraction.

Conclusions. Off-pump cardiopulmonary bypass avoids the risks of cardiopulmonary bypass and atrial trauma. A substantially lower stroke rate suggests that OPCAB is a neurologically safe treatment option for revascularization.




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