Impact of Aortic Manipulation on High Perioperative Cerebral Stroke Risk Undergoing Coronary Artery Bypass Grafting: Results from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting)

Objectives: Coronary artery bypass graft (CABG) without cardiopulmonary bypass and minimal or no aortic manipulation may reduce postoperative neurologic event.

Methods: Data from the prospective E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) conducted between January 2015 and December 2016 at 16 European centers were analyzed. A total of 7,352 patients were included in the E-CABG study, of those 684 patients with high neurologic risk due to (1) previous stroke or transient ischemic attack, (2) severe carotid stenosis or occlusion, and (3) previous carotid artery intervention) were included. We compared postoperative neurologic event as primary outcome and other major complication (MACCE: myocardial infarction, coronary re-revascularization, and all causes of death) as secondary outcome between off-pump CABG (OPCAB) and on-pump with or without cross-clamping.

Result: Neurologic events were higher in cross-clamp group (without vs. with cross-clamp 2.0 vs. 4.5%, p = 0.143; propensity score matching 1 vs. 7%, p = 0.018). Complete aortic no-touch technique showed a low incidence of neurologic events (0.7%) as compared with the cross-clamp group (5%). There was no significant difference with regard to secondary outcome.

Conclusion: Avoidance or reduction of aortic manipulation in CABG decreases the risk of postoperative neurologic complication, especially in patients with increased event risk.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021