Off-Pump Coronary Artery Bypass Grafting and Stroke—Exploratory Analysis of the GOPCABE Trial and Methodological Considerations

Wilko Reents; Michael Zacher; Jochen Boergermann; Utz Kappert; Michael Hilker; Gloria Färber; Marc Albert; David Holzhey; Lenard Conradi; Friedrich Christian Riess; Philippe Veeckman; Justus T. Strauch; Anno Diegeler; Andreas Böning

doi:10.1055/s-0038-1636936

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2018; 66(06): 464-469
DOI: 10.1055/s-0038-1636936

Original Cardiovascular

Georg Thieme Verlag KG Stuttgart · New York

Off-Pump Coronary Artery Bypass Grafting and Stroke—Exploratory Analysis of the GOPCABE Trial and Methodological Considerations

Wilko Reents

¹Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany

,

Michael Zacher

¹Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany

,

Jochen Boergermann

²Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, NRW, Germany

,

Utz Kappert

³Herzzentrum Dresden, Dresden, Germany

,

Michael Hilker

⁴Herz-, Thorax- und herznahe Gefäßchirurgie, Regensburg, Germany

,

Gloria Färber

⁵Department of Cardiac and Thoracic Surgery, University of Jena, Jena, Germany

,

Marc Albert

⁶Herzchirurgie, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Baden-Württemberg, Germany

,

David Holzhey

⁷Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany

,

Lenard Conradi

⁸Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany

,

Friedrich Christian Riess

⁹Department of Cardiac Surgery, Albertinenkrankenhaus, Hamburg, Germany

,

Philippe Veeckman

¹⁰HELIOS Klinik fur Herzchirurgie Karlsruhe, Karlsruhe, Baden-Württemberg, Germany

,

Justus T. Strauch

¹¹Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany

,

Anno Diegeler

¹Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany

,

Andreas Böning

¹²Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany

› Author Affiliations

Abstract

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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 CABG may be offset by the complexity of the operative therapy as well as the multiple pathomechanisms involved in perioperative stroke.

Keywords

off-pump surgery - coronary artery bypass grafting - CABG - stroke

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References

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