Title of article :
Stroke after conventional versus minimally invasive coronary artery bypass
Author/Authors :
Sotiris C. Stamou، نويسنده , , Kathleen A. Jablonski، نويسنده , , Albert J. Pfister، نويسنده , , Peter C. Hill، نويسنده , , Mercedes K. C. Dullum، نويسنده , , Ammar S. Bafi، نويسنده , , Steven W. Boyce، نويسنده , , Kathleen R. Petro، نويسنده , , Paul J. Corso، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2002
Pages :
6
From page :
394
To page :
399
Abstract :
Background. Postoperative stroke is a serious complication after coronary artery bypass grafting with cardiopulmonary bypass (on-pump), and portends higher morbidity and mortality. It is unknown whether an off-pump cardiopulmonary bypass (OPCAB) approach may yield a lower stroke rate over conventional on-pump coronary artery bypass grafting. Methods. From June 1994 to December 2000, OPCAB was performed in 2,320 patients and compared with 8,069 patients who had on-pump coronary artery bypass grafting, during the same period of time. The patients undergoing OPCAB were randomly matched to on-pump patients by propensity score. A logistic regression model was used to test the difference in the postoperative stroke rate between OPCAB and on-pump procedures controlling for the correlation between matched sets. A multiple logistic regression model predicting the risk of stroke adjusted by stroke risk factors and operation type was also computed. Results. Matches by propensity score were found for 72% of the patients undergoing OPCAB. Patients undergoing on-pump coronary artery bypass grafting were 1.8 (95% confidence interval 1.0 to 3.1, p = 0.03) times more likely to suffer a stroke postoperatively than OPCAB patients after controlling for preoperative risk factors through matching. Independent predictors of stroke identified from the multiple logistic model included on-pump operation (versus OPCAB operation), female gender, 4 to 6 vessels grafted (versus <4 grafts), hypertension, history of previous cerebrovascular accident, carotid artery disease, chronic obstructive pulmonary disease, and depressed ejection fraction. Conclusions. Off-pump cardiopulmonary bypass avoids the risks of cardiopulmonary bypass and atrial trauma. A substantially lower stroke rate suggests that OPCAB is a neurologically safe treatment option for revascularization.
Journal title :
The Annals of Thoracic Surgery
Serial Year :
2002
Journal title :
The Annals of Thoracic Surgery
Record number :
605841
Link To Document :
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