HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Keiju Kotoh Kazuaki Fukahara Takuro Misaki Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kotoh, K. Articles by Misaki, T. Search for Related Content PubMed PubMed Citation Articles by Kotoh, K. Articles by Misaki, T. Related Collections Coronary disease

Ann Thorac Surg 2007;83:1679-1683
© 2007 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Predictors of Early Postoperative Cerebral Infarction After Isolated Off-Pump Coronary Artery Bypass Grafting

Department of Surgery, University of Toyama, Toyama, Japan

Accepted for publication December 29, 2006.

^_* Address correspondence to Dr Kotoh, Department of Surgery, University of Toyama, 2630 Sugitani Toyama, Japan, 930-0194 (Email: kotoh{at}med.u-toyama.ac.jp).

Background: Risk factors associated with cerebral infarction within 7 days after off-pump coronary artery bypass grafting require further statistical elucidation.

Methods: From January 1997 to July 2006, off-pump coronary artery bypass grafting was performed in 576 patients at Toyama University Hospital. Factors including previous cerebral infarction, lesions in head and neck vessels, preoperative cerebral ischemic symptoms, intraaortic balloon pump use, number of coronary lesions, number of coronary bypasses, sites of coronary bypasses, number of proximal anastomoses in the ascending aorta, use of aortic no-touch procedure, partial aortic clamping, automatic proximal anastomosis devices, and a proximal seal system were compared retrospectively between patients with and without early cerebral infarction. Factors differing between groups were analyzed further by multivariate logistic regression.

Results: Ten patients (1.7%) had cerebral infarction within 7 days after surgery. The subjects were divided into two groups, those who had cerebral infarction after surgery (n = 10) and those who did not (n = 566). Factors showing significant intergroup differences were a previous history of cerebral infarction (p < 0.001), preoperative presence of cerebral ischemic symptoms (p < 0.001), vascular lesions in head and neck vessels (p < 0.001), use of partial aortic clamping (p = 0.002), and postoperative atrial fibrillation within 7 days after surgery (p = 0.011). Multiple logistic regression analysis indicated close relationships between previous history of cerebral infarction (odds ratio, 26.6; 95% confidence interval, 2.8 to 251.1; p = 0.004), preoperative presence of cerebral ischemic symptoms plus lesions in head and neck vessels (odds ratio, 22.8; 95% confidence interval 1.8 to 285.7; p = 0.015), and use of partial aortic clamping (odds ratio, 11.1; 95% confidence interval, 1.4 to 85.7; p = 0.021). Postoperative atrial fibrillation within 7 days after surgery (odds ratio, 3.4; 95% confidence interval, 0.7 to 16.5; p = 0.121) was suspected as a risk factor for postoperative cerebral infarction.

Conclusions: Multivariate analysis identified independent factors strongly associated with cerebral infarction after off-pump coronary artery bypass grafting, such as partial aortic clamping, presence of cerebral ischemic symptoms plus head and neck vascular lesions, and previous cerebral infarction.

This article has been cited by other articles:

				A. Castellheim, T. N. Hoel, V. Videm, E. Fosse, A. Pharo, J. L. Svennevig, A. E. Fiane, and T. E. Mollnes Biomarker Profile in Off-Pump and On-Pump Coronary Artery Bypass Grafting Surgery in Low-Risk Patients Ann. Thorac. Surg., June 1, 2008; 85(6): 1994 - 2002. [Abstract] [Full Text] [PDF]

				D. van de Beek, W. Kremers, R. C. Daly, B. S. Edwards, A. L. Clavell, C. G. A. McGregor, and E. F. M. Wijdicks Effect of Neurologic Complications on Outcome After Heart Transplant Arch Neurol, February 1, 2008; 65(2): 226 - 231. [Abstract] [Full Text] [PDF]