Reents, Wilko and Zacher, Michael and Boergermann, Jochen and Kappert, Utz and Hilker, Michael and Faerber, Gloria and Albert, Marc and Holzhey, David and Conradi, Lenard and Riess, Friedrich Christian and Veeckman, Philippe and Strauch, Justus T. and Diegeler, Anno and Boening, Andreas (2018) Off-Pump Coronary Artery Bypass Grafting and Stroke-Exploratory Analysis of the GOPCABE Trial and Methodological Considerations. THORACIC AND CARDIOVASCULAR SURGEON, 66 (6). pp. 464-469. ISSN 0171-6425, 1439-1902
Full text not available from this repository. (Request a copy)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 CABGmay be offset by the complexity of the operative therapy as well as the multiple pathomechanisms involved in perioperative stroke.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ON-PUMP; CARDIOPULMONARY BYPASS; ELDERLY-PATIENTS; CARDIAC-SURGERY; RISK-FACTORS; OUTCOMES; DISEASE; off-pump surgery; coronary artery bypass grafting; CABG; stroke |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 09 Jan 2020 08:17 |
| Last Modified: | 09 Jan 2020 08:17 |
| URI: | https://pred.uni-regensburg.de/id/eprint/13960 |
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