STROKE AFTER ON-PUMP AND OFF-PUMP CORONARY SURGERY: INCIDENCE, PREDICTORS AND OUTCOME

Background: The stroke remains a devastating complication after cardiac surgical procedures despite advances in perioperative monitoring and management. The purpose of the present study was to investigate the incidence, predictors and outcome of stroke after on-pump and off-pump coronary artery bypass grafting (CABG). Methods: From January 1999 to June 2005, 703 consecutive patients aged >= 60 underwent isolated coronary artery bypass surgery in our institution. Before 2002, the myocardial revascularization was performed off-pump at the discretion of the operating surgeon. After this period, our strategy was to plan starting the CABG without the cardiopulmonary bypass (CPB) in patients over 60 years. In accordance with our off-pump CABG (OPCAB) policy, our inclusion criterion was the age over 60 years. On-pump CABG (ONCAB) was performed in 289 (41.1%) patients and OPCAB in 414 (58.9%) patients. Perioperative neurological events were diagnosed by neurologists and were defined as any new neurological deficit during the postoperative period. Results: The incidence of stroke was 2.6% (n = 18) and significantly higher in ONCAB group compared with OPCAB patients (5.9% and 0.25%, respectively; p = 0.001). Multivariable logistic regression analysis revealed four independent predictors of postoperative stroke: cardiopulmonary bypass (p = 0.001; odds ratio (OR) 30.76), preoperative atrial fibrillation (p = 0.023; OR 7.52), peripherial vascular disease (p = 0.024; OR 4.28) and left main stenosis (p = 0.026; OR 3.24). The in-hospital mortality (4.8% and 1.2%, respectively; p = 0.004), renal failure (4.5% and 1.9%, respectively; p = 0.039), wound infection (11.8% and 7%, respectively; p = 0.022), acute cardiac failure (3.5% and 0.5%, respectively; p = 0.005), need for intra-aortic balloon pump (2.8% and 0%, respectively; p = 0.001) and prolonged intensive care unit stay (20.4% vs 9.2%, respectively; p = 0.001), ventilation time (11.4% vs 5.1%, respectively; p = 0.002) and length of hospital stay (23.5% vs 16.7%, respectively; p = 0.026) were all significantly greater in the ONCAB population. Conclusions: The stroke is a devastating complication of coronary surgery. In this study OPCAB, compared with ONCAB surgery reduced neurologic and clinical morbidity, mortality, as well as hospital stay.