Document Detail

A multimodal approach to the prevention of postoperative stroke in patients undergoing coronary artery bypass surgery.
MedLine Citation:
PMID:  19321157     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Stroke is known to be multifactorial in origin. This study was designed to assess the effectiveness of a multimodal approach to preventing this complication in patients undergoing coronary artery bypass. METHODS: One thousand five hundred thirty consecutive coronary artery bypass patients operated on by a single surgeon from July 1994 to April 2008 were studied. Group 1 patients (n = 1,214) were operated on before 2004. Group 2 patients (n = 316) were operated on after 2004. In group 2 patients, epiaortic scanning, selective use of proximal anastomotic devices, and alternative cannulation were used. Off-pump coronary artery bypass (OPCAB) was used in 730 patients. On-pump coronary artery bypass (ONCAB) was used in 800 patients. Preoperative risk factors including age, cerebrovascular disease, peripheral vascular disease, hypertension, and diabetes were examined in all patients. The incidence of postoperative stroke was determined for group 1 and 2 patients and the individual cohorts of OPCAB and ONCAB patients. RESULTS: The overall incidence of stroke was 1.6% (25/1,530). The postoperative incidence of stroke was 1.7% (21/1,214) in group 1 patients as compared with 1.3% (4/316) in group 2 patients. The incidence of postoperative stroke was 2.4% (19/800) in ONCAB patients as compared with 0.8% (6/730) in OPCAB patients (P < .05). CONCLUSIONS: OPCAB is an important tool for the prevention of postoperative stroke. Adjunctive techniques for the prevention of emboli from the ascending aorta may also reduce the risk of stroke in OPCAB and ONCAB patients.
James M Douglas; Susan E Spaniol
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Publication Detail:
Type:  Journal Article     Date:  2009-03-24
Journal Detail:
Title:  American journal of surgery     Volume:  197     ISSN:  1879-1883     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-27     Completed Date:  2009-05-15     Revised Date:  2009-05-20    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  587-90     Citation Subset:  AIM; IM    
Cardiothoracic Surgery Associates, PeaceHealth Medical Group, St Joseph Hospital, Bellingham, WA 98225, USA.
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MeSH Terms
Coronary Artery Bypass / adverse effects*
Coronary Artery Bypass, Off-Pump
Middle Aged
Postoperative Complications / epidemiology,  prevention & control*
Retrospective Studies
Risk Factors
Stroke / epidemiology,  prevention & control*

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