• Wilko Reents, Michael Zacher, Jochen Boergermann, Utz Kappert, Michael Hilker, Gloria Färber, Marc Albert, David Holzhey, Lenard Conradi, Friedrich Christian Riess, Philippe Veeckman, Justus T Strauch, Anno Diegeler, and Andreas Böning.
• Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany.
• Thorac Cardiovasc Surg. 2018 Sep 1; 66 (6): 464-469.

BackgroundCoronary artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG) may reduce severe adverse events including stroke.MethodsIn the German Off-Pump Coronary Artery Bypass Grafting in Elderly patients trial, the rate of major adverse cardiovascular events was compared in 2,394 elderly (≥ 75 years) patients undergoing CABG with (on-pump) or without (off-pump) cardiopulmonary bypass. This exploratory post-hoc analysis investigated the impact of surgical aortic manipulation on the rate of stroke.ResultsThere was no significant difference in the rate of stroke within 30 days after surgery between both groups (off-pump: 2.2%; on-pump: 2.7%; odds ratio [OR]: 0.83 [0.5-1.38]; p = 0.47). Within the off-pump group, different degrees of aortic manipulation did not lead to significant different stroke rates (tangential clamping: 2.3%; OR 0.86 [0.46-1.60]; clampless device: 1.8%; OR 0.67 [0.26-1.75]; no aortic manipulation: 2.4%; OR 0.88 [0.37-2.14]). An aggregate analysis including more than 10,000 patients out of the four recent major trials also yielded comparable stroke rates for on- and off-pump CABG (off-pump: 1.4%; on-pump: 1.7%; OR 0.87 [0.64-1.20]).ConclusionWithin recent prospective randomized multicenter trials off-pump CABG did not result in lower stroke rates. The possible intrinsic benefit of off-pump CABG may be offset by the complexity of the operative therapy as well as the multiple pathomechanisms involved in perioperative stroke.Georg Thieme Verlag KG Stuttgart · New York.

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