Stroke after CABG. How We Reduce It! Single-centre Prospective Study of 4000 Patients

Pavel Myalyuk, Andrey Marchenko, Alexey Vronskiy

FCCVS n.a. S.G. Suhanov, Perm, Russia., Perm, Russia

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – C

Abstract

INTRODUCTION AND AIMS:For more than 50 years of existence, coronary bypass cultivate ways to reduce complications. Despite this, the incidence of cerebrovascular complications after revascularization remains within 0.8 - 4.2%, according to different authors. The aim of this study is to develop and assess the effectiveness of the differentiated approach to choice the optimal tactics of coronary bypass surgery for reduce stroke after CABG.

METHODS: During the period from 01.01.2014 to 04.06.2016 we performed 4000 coronary bypass grafting. The average age of 61.2 ± 12.2, men 2716 (67.9%), obese in 1262 (31.6%), diabetes was diagnosed in 324 (8.1%) patients, permanent atrial fibrillation in 96 (2.4%), left ventricular ejection fraction less than 30% in 36 (0.9%), unstable angina in 428 (10.7%). We divided the patients into 2 groups: 1 - 2689 patients, and 2 - 1312 patients we used differentiated approach. In 1 group, patients underwent standard coronary artery bypass grafting. For Patients in 2 group we include into examination transesophageal echocardiography, CT and epiaortic ultrasound scanning. If the aorta is normal patients underwent standard coronary artery bypass grafting - 1002 (76.4%). Atheromatosis or plaques protruding into the lumen more than 5 mm or local calcinosis of aorta were detected in 325 patients. In all of them, we had changed the surgical tactics. Modifications applied: place of cannulation and place of clamping changing - 166 (12.7%), «Single clamp» - 78 (5.9%), «on pump beating» - 49 (3.7%), «no-touch aorta» - 32 (2.4%).

RESULTS: overall hospital mortality was 1.1% (38). Perioperative stroke 33 (1.4%) in the group 1, and 0 mortality and stroke in group2 .

CONCLUSIONS: Differentiated approach to surgical tactics choice, reduces the risk of neurological complications when atherosclerosis of the ascending aorta is detected after CABG.