Document Detail


Avoiding the clamp during off-pump coronary artery bypass reduces cerebral embolic events: results of a prospective randomized trial.
MedLine Citation:
PMID:  22108921     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purpose of this study was to determine whether a clampless facilitating device (CFD) to perform proximal aortocoronary anastomoses would result in a lower incidence of cerebral embolic events compared with a partial clamping strategy during off-pump coronary artery bypass (OPCAB). After epiaortic ultrasound confirmed the mild aortic disease (Grades I and II), 57 patients were randomly assigned to have proximal anastomoses using a partial-occluding clamp (CL, n = 28) or a CFD [Heartstring (HS), n = 29] (Maquet Cardiovascular LLC, San Jose, CA). Solid and gaseous emboli in the middle cerebral arteries were detected using transcranial Doppler ultrasonography. The mean number of proximal anastomoses was similar between groups 1.93 ± 0.72 (CL) and 1.72 ± 0.70 (HS) (P = 0.28). The mean number of gaseous plus solid emboli was greater in the CL group than the HS group (90.0 ± 64.0 vs. 50.8 ± 36.6, P = 0.01). Emboli were fewest in patients undergoing HS anastomoses using the suction device. The number of intraoperative cerebral emboli was proportional to the number of proximal anastomoses in the HS groups, but independent of the number of proximal anastomoses in the CL groups. Among patients with a low burden of aortic atherosclerosis, partial clamping of the ascending aorta during OPCAB was associated with more cerebral embolic events compared with an anastomosis with a CFD.
Authors:
Hisham El Zayat; John D Puskas; Scott Hwang; Vinod H Thourani; Omar M Lattouf; Patrick Kilgo; Michael E Halkos
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-11-18
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  14     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-10     Completed Date:  2012-05-22     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  12-6     Citation Subset:  IM    
Affiliation:
Division of Cardiothoracic Surgery, Emory University School of Medicine, Clinical Research Unit, Atlanta, GA, USA.
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MeSH Terms
Descriptor/Qualifier:
Coronary Artery Bypass, Off-Pump / adverse effects*,  methods
Coronary Stenosis / surgery*
Equipment Safety
Female
Follow-Up Studies
Humans
Incidence
Intracranial Embolism / etiology,  prevention & control*,  ultrasonography
Intraoperative Complications / prevention & control*,  ultrasonography
Male
Middle Aged
Monitoring, Intraoperative / methods
Prognosis
Prospective Studies
Surgical Instruments / adverse effects*
Ultrasonography, Doppler, Transcranial
United States / epidemiology
Comments/Corrections

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