Neurological outcomes after on-pump vs off-pump CABG in patients with cerebrovascular disease

Autor: Massimo Chello, Francesco Santini, Antonio Nenna, Antonio Salsano, Giovanni Mariscalco, Cristiano Spadaccio, Carmelo Dominici, Zein El-Dean, Mohamad Bashir
Rok vydání: 2019
Předmět:
Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
off-pump
delirium
myocardial revascularization
stroke
Coronary Artery Bypass
Off-Pump
Coronary Artery Disease
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Postoperative stroke
Postoperative Complications
Risk Factors
Internal medicine
medicine
Humans
In patient
cardiovascular diseases
Propensity Score
Stroke
Aged
Retrospective Studies
business.industry
Incidence (epidemiology)
Incidence
Odds ratio
medicine.disease
United Kingdom
medicine.anatomical_structure
Treatment Outcome
030228 respiratory system
Italy
Ischemic Attack
Transient
Propensity score matching
Cardiology
Delirium
Surgery
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Artery
Follow-Up Studies
Zdroj: Journal of cardiac surgery. 34(10)
ISSN: 1540-8191
Popis: Background and aim of the study The possible association of off-pump coronary artery bypass graft (CABG) with reduced risk of postoperative stroke and enhanced benefits in high-risk patients support the hypothesis that patients with a positive history of cerebrovascular disease would benefit from off-pump coronary surgery. This study aims to investigate the impact of off-pump CABG on the incidence of postoperative neurologic events in patients with a previous history of cerebrovascular disease. Methods From January 2015 to September 2018, 414 patients underwent isolated CABG with a previous history of transient ischemic attack (TIA) or stroke: 295 patients had on-pump CABG and 119 patients had off-pump CABG. Neurological outcomes of interest are postoperative stroke (transient or permanent), delirium requiring pharmacological treatment or a combination of both, collectively defined "Major Adverse Neurological Events" (MANE). Propensity score (PS) adjusted analysis has been used for regression models. Results Off-pump CABG carried a lower incidence of postoperative stroke (3.4% vs 9.8%, P = .046, PS-adjusted odds ratio 0.34 with P = .044). Postoperative delirium occurred more than twice as often in the on-pump group (11.5% vs 4.2%, P = .034, PS-adjusted odds ratio 2.78 with P = .043). The composite outcome of MANE occurred in 20.3% in the on-pump group, and in 7.6% in the off-pump group (P = .003). Other complications were similar between groups. Conclusions In patients with a previous TIA or stroke, off-pump CABG is associated with a reduced risk of stroke, delirium, and postoperative adverse neurological events, compared to on-pump CABG. Patients with high neurological risk can potentially benefit from off-pump CABG, due to an overall reduction of postoperative neurological complications.
Databáze: OpenAIRE
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