Thorac Cardiovasc Surg 2018; 66(06): 464-469
DOI: 10.1055/s-0038-1636936
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Off-Pump Coronary Artery Bypass Grafting and Stroke—Exploratory Analysis of the GOPCABE Trial and Methodological Considerations

Wilko Reents
1  Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany
,
Michael Zacher
1  Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany
,
Jochen Boergermann
2  Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, NRW, Germany
,
Utz Kappert
3  Herzzentrum Dresden, Dresden, Germany
,
Michael Hilker
4  Herz-, Thorax- und herznahe Gefäßchirurgie, Regensburg, Germany
,
Gloria Färber
5  Department of Cardiac and Thoracic Surgery, University of Jena, Jena, Germany
,
Marc Albert
6  Herzchirurgie, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Baden-Württemberg, Germany
,
David Holzhey
7  Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
,
Lenard Conradi
8  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Friedrich Christian Riess
9  Department of Cardiac Surgery, Albertinenkrankenhaus, Hamburg, Germany
,
Philippe Veeckman
10  HELIOS Klinik fur Herzchirurgie Karlsruhe, Karlsruhe, Baden-Württemberg, Germany
,
Justus T. Strauch
11  Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany
,
Anno Diegeler
1  Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany
,
Andreas Böning
12  Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
› Author Affiliations
Further Information

Publication History

16 October 2017

05 January 2018

Publication Date:
22 March 2018 (online)

Abstract

Background Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG) may reduce severe adverse events including stroke.

Methods In 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.

Results There 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]).

Conclusion Within 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.