The North Pacific Surgical AssociationA multimodal approach to the prevention of postoperative stroke in patients undergoing coronary artery bypass surgery
Section snippets
Methods
One thousand five hundred thirty consecutive patients undergoing coronary bypass grafting by a single surgeon (JD) at Saint Joseph Hospital were reviewed. Group 1 patients (n = 1,214) were operated on between July 27, 1994, and December 31, 2003. Group 2 patients (n = 316) were operated on between January 1, 2004, and March 31, 2008.
In group 1 patients, off-pump bypass was performed whenever achievable, according to the surgeon's preference, after 1997. All other patients underwent conventional
Results
A total of 1,530 patients were retrospectively reviewed. These patients were compared as groups representing 2 eras of patient-management strategy by a single surgeon. Additionally, the patient population who underwent conventional coronary artery bypass grafting on pump was compared with those patients who underwent off-pump coronary artery bypass grafting. The primary endpoint was the postoperative incidence of stroke. The overall incidence of stroke was 1.6% (25/1,530).
On average, group2
Comments
A substantial volume of research over the years has examined the etiology and risk factors for postoperative stroke in patients undergoing coronary bypass surgery.1, 2, 3 Studies have consistently shown the strong association between both microemboli and macroemboli with the subsequent development of adverse neurologic events.3, 12 Transcranial Doppler ultrasound studies have confirmed peak incidences of embolization occurring during times of arterial cannulation, aortic cross-clamping and
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