Medium-term neurological complications after off-pump coronary artery bypass grafting with and without aortic manipulation

Coron Artery Dis. 2013 Sep;24(6):475-80. doi: 10.1097/MCA.0b013e3283632558.


Background: This study aimed to assess the impact of aortic manipulation during off-pump coronary artery bypass (OPCAB) on neurological complications.

Methods and results: Of 336 isolated OPCAB surgeries, the aorta was untouched in 264 cases (group A), whereas it was manipulated by a side-biting clamp in 72 (group B). The average follow-up was 2.9±2.5 years. One patient in each group developed postoperative stroke (P=0.38). The prevalence of triple-vessel disease (group A 40.9% vs. group B 61.1%; P=0.0003) and left main trunk disease (group A 30.7% vs. group B 47.2%; P=0.1) was lower in group A than in group B. The number of bypass grafts (group A 2.18±0.97 vs. group B 3.00±0.97; P=0.0001) was lower in group A than in group B. The prevalence of preoperative atrial fibrillation and the incidence of new-onset postoperative atrial fibrillation were not different between groups (P=0.74 and 0.86, respectively). Survival rate and freedom from major adverse cardiac events were not different between groups (P=0.87 and 0.51, respectively). However, freedom from neurological complications was significantly lower in group A (P=0.0006). The Cox hazard model showed that aortic manipulation (P=0.004; odds ratio, 6.18; 95% confidence interval, 1.8-21.6) and preoperative atrial fibrillation (P=0.001; odds ratio, 14.0; 95% confidence interval, 2.7-72.5) were risk factors for neurological complications.

Conclusion: Although there was no difference in the incidence of immediate postoperative neurological complications, there were fewer medium-term neurological complications in OPCAB cases without aortic manipulation.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Aged
  • Anastomosis, Surgical
  • Aorta / surgery*
  • Atrial Fibrillation / mortality
  • Chi-Square Distribution
  • Constriction
  • Coronary Artery Bypass, Off-Pump / adverse effects*
  • Coronary Artery Bypass, Off-Pump / mortality
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Incidence
  • Japan / epidemiology
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Stroke / epidemiology*
  • Stroke / mortality
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures / adverse effects*
  • Vascular Surgical Procedures / mortality