A multimodal approach to the prevention of postoperative stroke in patients undergoing coronary artery bypass surgery |
| |
| Authors: | James M. Douglas Susan E. Spaniol |
| |
| Affiliation: | Cardiothoracic Surgery Associates, PeaceHealth Medical Group, St. Joseph Hospital, 2979 Squalicum Parkway, Suite 201, Bellingham, WA 98225, USA;From McMaster University (Beiko), Saint Catharines, Ontario, Canada; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA;From the Glaucoma Center of Michigan (Siegel), Southfield, the Kresge Eye Institute (Siegel), Wayne State University, Detroit, and the Department of Ophthalmology (Siegel), William Beaumont Hospital, Royal Oak, Michigan; the Department of Ophthalmology (Condon), Allegheny General Hospital, Pittsburgh, Pennsylvania, USA;From Ruhr University Eye Clinic (Conrad-Hengerer, Schultz, Dick), Bochum, and Goethe University Eye Clinic (Hengerer), Frankfurt, Germany;From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA;From a private practice, Kolkata, India;From the Department of Ophthalmology and Vision Sciences (Gooi, Ahmed), University of Toronto, Toronto, the Department of Ophthalmology (Teichman), University of Ottawa, Ottawa, Trillium Health Partners (Ahmed), and the Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada |
| |
| Abstract: | BackgroundStroke 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.MethodsOne 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.ResultsThe 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).ConclusionsOPCAB 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. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
