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CLINICAL RESEARCH: COMPLICATIONS OF BYPASS SURGERY

Chronologic distribution of stroke after minimally invasive versus conventional coronary artery bypass

Garrett K. Peel, MHS^*, Sotiris C. Stamou, MD, PhD^,*, Mercedes K. C. Dullum, MD^*, Peter C. Hill, MD^*, Kathleen A. Jablonski, PhD, Ammar S. Bafi, MD^*, Steven W. Boyce, MD^*, Kathleen R. Petro, MD^* and Paul J. Corso, MD^*,*

^* Section of Cardiac Surgery, Washington Hospital Center, Washington, DC, USA
Section of Cardiac Surgery, Georgetown University Hospital, Washington, DC, USA
Statistics and Computer Center, MedStar Research Institute, Washington, DC, USA

Manuscript received May 5, 2003; revised manuscript received September 25, 2003, accepted September 29, 2003.

^* Correspondence: Dr. Sotiris C. Stamou, 1201 South Eads Street, Apt. 1909, Arlington, Virginia 22202, USA.
cvsisfun{at}hotmail.com

^* Reprint requests: Dr. Paul J. Corso, Chief, Section of Cardiac Surgery, Washington Hospital Center, 106 Irving Street NW, Suite 316, South Tower, Washington, DC 20010, USA.
paul.j.corso{at}MedStar.net

OBJECTIVES: We sought to investigate whether the chronologic distribution of the onset of stroke occurring after coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass (off-pump CABG) is different from the conventional on-pump approach (CABG with cardiopulmonary bypass).

BACKGROUND: Off-pump CABG has been associated with a lower stroke rate, compared with conventional on-pump CABG. However, it is unknown whether the chronologic distribution of the onset of stroke is different between the two approaches.

METHODS: We evaluated the chronologic distribution of postoperative stroke in patients undergoing CABG from June 1996 to August 2001 (n = 10,573). Preoperative risk factors for stroke were identified using the Northern New England preoperative estimate of stroke risk. Multivariate logistic regression analysis was used to determine the independent predictors of early stroke and to delineate the association between the surgical approach and the chronologic distribution of the onset of stroke.

RESULTS: Stroke occurred in 217 patients (2%, n = 10,573). A total of 44 (20%) and 173 (80%) of these patients had stroke after off-pump CABG and on-pump CABG, respectively. The median time for the onset of stroke was two days (range 0 to 11 days) after on-pump CABG versus four days (range 0 to 14 days) after off-pump CABG (p < 0.01). On-pump CABG was associated with a higher risk of early stroke (odds ratio 5.3, 95% confidence interval 2.6 to 10.9; p < 0.01) compared with off-pump CABG.

CONCLUSIONS: Compared with off-pump CABG, on-pump CABG is associated with an earlier onset of postoperative stroke during the recovery phase, suggesting different mechanisms in the pathogenesis of stroke between the two surgical approaches.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   off-pump CABG = CABG without cardiopulmonary bypass   on-pump CABG = CABG with cardiopulmonary bypass   NNE = Northern New England

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