Side clamp used during off-pump coronary artery bypass does not increase the risk of stroke.

BACKGROUND: The purpose of this study was to investigate whether the incidence of stroke after off-pump AC bypass was lower than that after on-pump AC bypass.

MATERIAL/METHODS: A prospective study was performed with consecutive patients who underwent isolated AC bypass in the Shin-Tokyo Hospital Group between July 1, 1996 and December 31, 2001 AC bypass was defined as coronary artery bypass requiring proximal anastomoses onto the ascending aorta. The patients were divided into two groups, depending on the use of cardiopulmonary bypass: on-pump and off-pump groups. Perioperative data were prospectively collected and the risk factors for postoperative stroke were investigated.

RESULTS: Preoperative comorbidities were more frequent in the off-pump group. The number of distal anastomoses was not significantly different but the number of proximal anastomoses was significantly greater in the on-pump group than in the off-pump group. The incidence of postoperative stroke was 0.3% in the off-pump group and 2.0% in the on-pump group. Significant risk factors influencing the occurrence of postoperative stroke included: use of cardiopulmonary bypass, age over 75, peripheral vascular disease, saphenous vein use, and postoperative atrial fibrillation. Multivariate analysis demonstrated that the use of cardiopulmonary bypass, age over 75, and peripheral vascular disease were isolated predictors of postoperative stroke.

CONCLUSIONS: The incidence of postoperative stroke was lower in the off-pump group than in the on-pump group, even though the side clamp was applied to the ascending aorta for aortocoronary bypass. The use of side clamping for off-pump AC bypass does not increase the risk of postoperative stroke.