Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598803
Oral Presentations
Monday, February 13th, 2017
DGTHG: Coronary Heart Disease: Off-pump ./. On-pump
Georg Thieme Verlag KG Stuttgart · New York

Stroke after On-pump or Off-pump Coronary Artery Bypass Grafting - Exploratory Analysis of the GOPCABE Trial

W. Reents
1   Herz-und Gefäßklinik Bad Neustadt, Kardiochirurgie, Bad Neustadt a. d. Saale, Germany
,
A. Böning
2   Universitätsklinik Giessen, Klinik für Herz- und Gefäßchirurgie, Gießen, Germany
,
U. Kappert
3   Herzzentrum Dresden Universitätsklinik, Dresden, Germany
,
M. Hilker
4   Universitätsklinikum Regensburg, Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Regensburg, Germany
,
T. Doenst
5   Universitätsklinik Jena, Klinik für Herz- und Thoraxchirurgie, Jena, Germany
,
A. Ursulescu
6   Robert-Bosch-Krankenhaus, Herzchirurgie, Stuttgart, Germany
,
A. Rastan
7   Herzzentrum Leipzig GmbH, Klinik für Herz- und Gefäßchirurgie, Leipzig, Germany
,
H. Treede
8   Universitäres Herzzentrum, Herz- und Gefäßchirurgie, Hamburg, Germany
,
F.C. Rieß
9   Albertinen Herz- und Gefäßzentrum, Kardiochirurgie, Hamburg, Germany
,
U. Mehlhorn
10   HELIOS Klinik für Herzchirurgie Karlsruhe GmbH, Karlsruhe, Germany
,
J. Strauch
11   Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil / Ruhr-Universität Bochum, Herz- und Thoraxchirurgie, Bochum, Germany
,
M. Zacher
1   Herz-und Gefäßklinik Bad Neustadt, Kardiochirurgie, Bad Neustadt a. d. Saale, Germany
,
A. Diegeler
1   Herz-und Gefäßklinik Bad Neustadt, Kardiochirurgie, Bad Neustadt a. d. Saale, Germany
,
J. Börgermann
12   Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

   All articles of this category

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

Methods: In the German Off Pump Coronary Artery Bypass in Elderly patients (GOPCABE) 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) CPB. 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 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 [0.47–1.60]; clampless device: 1.8%; OR: 0.53 [0.06–4.69]; no aortic manipulation: 2.4%; OR: 1.19 [0.35–4.06]). 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.