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Báo cáo y học: " Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational analysis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational analysis. | Hilker et al. Journal of Cardiothoracic Surgery 2010 5 14 http www.cardiothoracicsurgery.Org content 5 1 14 JOURNAL OF CARDIOTHORACIC SURGERY RESEARCH ARTICLE Open Access Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery a retrospective observational analysis Michael Hilker 1 Mathias Arlt2 Andreas Keyser1 Simon Schopka1 Alexander Klose1 Claudius Diez1 and Christof Schmid1 Abstract Objectives Stroke is a devastating complication after coronary artery bypass grafting occurring in 1.4 to 4.3 of patients. A major cause of stroke is cerebral embolization of aortic atheromatous debris or calcified plaques. This report analyzes the incidence of stroke in patients treated according to the clampless concept i.e. avoiding side-clamping of the aorta by means of off-pump coronary artery bypass surgery OPCAB in combination with the HEARTSTRING device. Methods During a period of 43 months 2005-2008 412 consecutive patients were treated with the abovementioned method by one single surgeon. A minimum of one proximal aortal anastomosis was performed in each patient. Altogether 542 proximal anastomosis were applied each created by means of the HEARTSTRING device. Results The mean age of patients was 67 9.7 years the predicted mortality 5.2 logistic EuroSCORE and the observed mortality 1.9 . Histories of preoperative neurological disorders or cerebrovascular diseases were documented in 15 of patients. The overall incidence of postoperative stroke was 0.48 in contrast to 1.3 according to the stroke risk score. Conclusions In accordance to previously published data our results show that avoiding aortic side-clamping during OPCAB reduces postoperative stroke rates. The HEARTSTRING device is a safe option for creating proximal aortic anastomosis. Background Cardiac surgery is increasingly conducted in elderly patients with extensive comorbidities. Various advances in surgical techniques and anesthetic management have improved patient outcome after coronary