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Aortic clamping strategy and postoperative stroke.

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Citation: Journal of Thoracic & Cardiovascular Surgery. 2018 Apr 13PMID: 29754790Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2018 Local holdings: Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006ISSN:

0022-5223

Name of journal: The Journal of thoracic and cardiovascular surgeryAbstract: CONCLUSIONS: Aortic clamping strategy for constructing proximal anastomoses in CABG procedures does not affect short-term incidence of postoperative stroke or mortality. The use of POC incurred shorter myocardial ischemic and perfusion times compared with the SC technique with similar total number of bypass grafts.Copyright (c) 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.METHODS: We identified 52,611 patients who underwent on-pump CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 1, 2014 to March 31, 2015. Propensity scores for POC were calculated on the basis of validated Society of Thoracic Surgeons predicted risk of postoperative stroke scores and used to adjust for intergroup differences to derive 17,819 matched pairs for analysis.OBJECTIVE: The effect of aortic clamping strategy on short-term stroke during proximal graft construction for coronary artery bypass grafting (CABG) remains undefined. The aim of this study was to test the hypothesis that partial occluding clamp (POC) technique does not increase incidence of postoperative stroke compared with single clamp (SC) technique for performing proximal coronary anastomoses.RESULTS: Despite a similar number of total bypass grafts between matched SC versus POC groups, myocardial ischemic times were shorter (74.1 +/- 29.2 minutes vs 57.0 +/- 23.3 minutes; P < .0001) as were cardiopulmonary bypass times (95.0 +/- 35.0 minutes vs 89.7 +/- 34.4 minutes; P < .0001) for the POC group. Postoperative stroke rates were similar between SC versus POC (0.9% vs 1.1%; risk ratio, 1.1; 95% confidence interval, 0.9-1.4; P = .3) as were mortality rates (1.3% vs 1.3%; risk ratio, 1.0; 95% confidence interval, 0.8-1.2; P = .9).All authors: Alaeddine M, Badhwar V, Brennan M, Chu D, Cook CC, Gleason TG, Grau-Sepulveda MV, Halkos ME, Jacobs JP, Matsouaka R, Meza J, Thourani VH, Wei LMFiscal year: FY2018Digital Object Identifier:

https://dx.doi.org/10.1016/j.jtcvs.2018.03.160

Date added to catalog: 2018-06-19

Holdings ( 1 )
Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	29754790	Available		29754790

Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: Aortic clamping strategy for constructing proximal anastomoses in CABG procedures does not affect short-term incidence of postoperative stroke or mortality. The use of POC incurred shorter myocardial ischemic and perfusion times compared with the SC technique with similar total number of bypass grafts.

METHODS: We identified 52,611 patients who underwent on-pump CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 1, 2014 to March 31, 2015. Propensity scores for POC were calculated on the basis of validated Society of Thoracic Surgeons predicted risk of postoperative stroke scores and used to adjust for intergroup differences to derive 17,819 matched pairs for analysis.

OBJECTIVE: The effect of aortic clamping strategy on short-term stroke during proximal graft construction for coronary artery bypass grafting (CABG) remains undefined. The aim of this study was to test the hypothesis that partial occluding clamp (POC) technique does not increase incidence of postoperative stroke compared with single clamp (SC) technique for performing proximal coronary anastomoses.

RESULTS: Despite a similar number of total bypass grafts between matched SC versus POC groups, myocardial ischemic times were shorter (74.1 +/- 29.2 minutes vs 57.0 +/- 23.3 minutes; P < .0001) as were cardiopulmonary bypass times (95.0 +/- 35.0 minutes vs 89.7 +/- 34.4 minutes; P < .0001) for the POC group. Postoperative stroke rates were similar between SC versus POC (0.9% vs 1.1%; risk ratio, 1.1; 95% confidence interval, 0.9-1.4; P = .3) as were mortality rates (1.3% vs 1.3%; risk ratio, 1.0; 95% confidence interval, 0.8-1.2; P = .9).

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