The Impact of Coronary Artery Bypass Grafting Surgical Technique on Stroke in Young and Elderly Patients
Background: Today, the elderly represent a large and rapidly growing segment of society and are being referred in increasing numbers for coronary artery bypass grafting (CABG) surgery. Stroke is a major complication of CABG surgery. The risk of stroke after CABG can be managed successfully, especially in high-risk patients, by choosing an adequate and appropriate surgical technique.
Methods: We evaluated 890 consecutive patients who underwent isolated CABG surgery by the same team between June 2006 and July 2008. The patients were divided by age into 2 groups. Group I consisted of 480 patients <65 years of age, and group II comprised 410 patients >65 years of age. Each group was then divided into 4 subgroups according to the surgical technique used: double-clamp technique (DCT), single-clamp technique (SCT), off-pump, and on-pump cross-clamp off. Preoperative risk factors for stroke and all clinical data were collected for the patients.
Results: In group I, 192 (40%) of the patients were female, and 288 (60%) were male. In group II, 170 (41.5%) were female, and 240 (58.5%) were male. Five patients in each group experienced stroke, with an incidence of 1.04% in group I (4 men and 1 woman) and 1.21% in group II (3 men and 2 women). The stroke rates of the 2 age groups were not significantly different (P = .802). Three of the 480 patients in group I died, with only 1 (33.3%) of the deaths related to stroke. In group II, however, 2 (50%) of the 4 deaths were related to stroke. The incidences of stroke-associated mortality in the 2 age groups were not significantly different (P = 1.0).
Conclusion: Although off-pump and on-pump cross-clamp off techniques were performed for some of the patients, DCT and SCT were used for the majority of the patients. We detected no statistically significant difference between these 2 groups of patients in the impact of applying DCT and SCT on the stroke rate. We conclude that this result was due to the different surgical techniques performed on a minority of the patients (82 patients).
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