Impact of Proximal Anastomosis Procedures on Stroke in Off‐Pump Coronary Artery Bypass Grafting

Manabe, Susumu; Fukui, Toshihiro; Miyajima, Keisuke; Watanabe, Yoshiyuki; Matsuyama, Shigefumi; Shimokawa, Tomoki; Takanashi, Shuichiro

doi:10.1111/j.1540-8191.2009.00911.x

Cited by 23 publications

(19 citation statements)

References 20 publications

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“…Patients were divided into 3 groups: (1) aortic “no‐touch”—8291 patients; (2) PAD—3192 patients; and (3) side‐clamp OPCAB—13 680 patients, respectively. Three of the included studies12, 17, 20 compared all 3 OPCAB techniques. Analysis of potential sources of bias is available in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Baseline characteristics of included studies, patient demographics, number of distal anastomoses, and PADs used are listed in Table 1. A total of 18 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] (among them 3 RCTs 24,26,27 ) comprising 25 163 patients met the inclusion criteria and entered the final analysis. Patients were divided into 3 groups: (1) aortic "no-touch"-8291 patients; (2) PAD -3192 patients; and (3) side-clamp OPCAB-13 680 patients, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Pawliszak

Kowalewski

Raffa

et al. 2016

JAHA

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BackgroundOff‐pump coronary artery bypass (OPCAB) has been shown to reduce the risk of neurologic complications as compared to coronary artery bypass grafting performed with cardiopulmonary bypass. Side‐clamping of the aorta while constructing proximal anastomoses, however, still carries substantial risk of cerebral embolization. We aimed to perform a comprehensive meta‐analysis of studies assessing 2 clampless techniques: aortic “no‐touch” and proximal anastomosis devices (PAD) for OPCAB.Methods and ResultsPubMed, CINAHL, CENTRAL, and Google Scholar databases were screened for randomized controlled trials and observational studies comparing “no‐touch” and/or PAD with side‐clamp OPCAB and reporting short‐term (≤30 days) outcomes: cerebrovascular accident and all‐cause mortality. A total of 18 studies (3 randomized controlled trials) enrolling 25 163 patients were included. Aortic “no‐touch” was associated with statistically lower risk of cerebrovascular accident as compared to side‐clamp OPCAB: risk ratio 95% CI: 0.41 (0.27–0.61); P<0.01; I2=0%. Event rates were 0.36% and 1.28% for “no‐touch” and side‐clamp OPCAB, respectively. No difference was seen between PAD and side‐clamp OPCAB: 0.71 (0.33–1.55); P=0.39; I2=39%. A trend towards increased 30‐day all‐cause mortality with PAD and no difference with “no‐touch” were observed when compared to side‐clamp OPCAB. In a subset analysis, “no‐touch” consistently reduced the risk of cerebrovascular accident regardless of patients’ baseline risk characteristics. A benefit with PAD was observed in low‐risk patients.ConclusionsAortic “no‐touch” technique was associated with nearly 60% lower risk of postoperative cerebrovascular events as compared to conventional side‐clamp OPCAB with effect consistent across patients at different risk.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Pawliszak

Kowalewski

Raffa

et al. 2016

JAHA

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“…The search in Clinicaltrials.gov yielded one study on Heartstring, which is still recruiting since 2006 and its results are, to our knowledge, still unpublished. We were able to retrieve data on the use of the Heartstring anastomotic device in coronary artery bypass grafting (CABG) from eight studies [13][14][15][16][17][18][19][20]. Among these studies, only two were of prospective nature.…”

Section: Resultsmentioning

confidence: 98%

Meta-analysis on the use of the Heartstring anastomotic device to prevent stroke in patients undergoing off-pump coronary artery bypass grafting

Biancari

Yli-Pyky

2011

European Journal of Cardio-Thoracic Surgery

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The results of this meta-analysis suggest that the risk of stroke after OPCAB may not be markedly reduced by the use of Heartstring device. On the other hand, a rather low rate of stroke was observed among patients with diseased ascending aorta indicating its potential value in these patients. Most of studies included in this meta-analysis were of poor methodological quality, and properly conducted prospective studies are needed to get more conclusive results on the safety and efficacy of Heartstring anastomosis device.

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“…In these cases, free grafts are attached either to the side of the in situ LIMA, as fi rst described by Tector and colleagues [ 139 ], or to the innominate, subclavian, or axillary artery if it is disease-free [ 140 ]. Alternatively, free grafts can be attached to a diseasefree area of the aorta with an automated anastomotic device [ 141 ], or with a clampless anastomotic facilitator that obviates the need for a partial-occluding clamp. Recent series suggest that using these clampless approaches to OPCAB results in low perioperative stroke and mortality rates [ 141 , 142 ], perhaps lower than those associated with conventional CABG [ 143 , 144 ].…”

Section: Results Of Off-pump Coronary Artery Bypassmentioning

confidence: 99%

Surgical Treatment of Coronary Artery Disease

Cohn

Frazier

Mallidi

et al. 2015

Cardiovascular Medicine

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Techniques and technology for treating coronary artery disease (CAD) have evolved significantly over the past 50 years. Although there are cases in which the best treatment approach (medical, surgical, or catheter-based) is clear, the best choice of intervention is not obvious for the majority of patients. Five, seven, and ten years after initial treatment, mortality is lower for coronary artery bypass grafting (CABG) than for medical treatment alone. The survival benefi ts of CABG are particularly substantial for patients with 3-vessel or left main artery disease, severe angina, or a positive pretreatment exercise stress test.Most trials that have compared CABG with percutaneous coronary intervention (PCI) in patients with multivessel disease have shown similar short-term survival benefi ts, but PCI has been associated with less periprocedural morbidity, including stroke, whereas CABG has been associated with longer-lasting revascularization.Technical innovations made in the attempt to reduce the negative impact of cardiopulmonary bypass (CPB) include reducing contact between blood and the CPB mechanism by coating the internal surface with heparin or other polymers, minimizing hemodilution by shrinking the bypass circuit to reduce the amount of crystalloid prime needed to start CPB, and using hemofi ltration to protect the heart and end organs. There is not yet complete agreement about the relative safety and effi cacy of off-pump coronary artery bypass (OPCAB) versus conventional CABG with CPB.Results of small randomized trials suggest that, in patients with stenosis of the proximal LAD, minimally invasive direct coronary artery bypass (MIDCAB) is associated with a longer in-hospital recovery period and higher costs than is direct stenting, but that MIDCAB produces similar or better short-and long-term outcomes. Totally endoscopic coronary artery bypass (TECAB) aided by computer-controlled surgical robotic devices has continued to slowly evolve over the last decade, and several centers have reported favorable results. The technical challenges and procedural costs have prevented the widespread application of this technology. • Techniques and technology for treating coronary artery disease (CAD) have evolved signifi cantly over the past 50 years.• Although there are cases in which the best treatment approach (medical, surgical, or catheterbased) is clear, the best choice of intervention is not obvious for the majority of patients.• Five, 7, and 10 years after initial treatment, mortality is lower for coronary artery bypass grafting (CABG) than for medical treatment alone. The survival benefi ts of CABG are particularly substantial for patients with 3-vessel or left main artery disease, severe angina, or a positive pretreatment exercise stress test.• Most trials that have compared CABG with percutaneous coronary intervention (PCI) in patients with multivessel disease have shown similar shortterm survival benefi ts, but PCI has been associated with less periprocedural morbidity, including stroke, whereas CA...

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Impact of Proximal Anastomosis Procedures on Stroke in Off‐Pump Coronary Artery Bypass Grafting

Cited by 23 publications

References 20 publications

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Meta-analysis on the use of the Heartstring anastomotic device to prevent stroke in patients undergoing off-pump coronary artery bypass grafting

Surgical Treatment of Coronary Artery Disease

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