Hilker Michael, Arlt Mathias, Keyser Andreas, Schopka Simon, Klose Alexander, Diez Claudius, Schmid Christof
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Germany.
J Cardiothorac Surg. 2010 Mar 25;5:14. doi: 10.1186/1749-8090-5-14.
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.
During a period of 43 months (2005-2008), 412 consecutive patients were treated with the above-mentioned 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.
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.
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.
中风是冠状动脉搭桥术后一种严重的并发症，发生率为1.4%至4.3%。中风的一个主要原因是主动脉粥样硬化碎片或钙化斑块的脑栓塞。本报告分析了采用非钳夹理念治疗的患者的中风发生率，即通过不停跳冠状动脉搭桥手术（OPCAB）结合HEARTSTRING装置避免主动脉侧钳夹。
在43个月（2005 - 2008年）期间，由一位外科医生连续对412例患者采用上述方法进行治疗。每位患者至少进行一次近端主动脉吻合。总共进行了542次近端吻合，每次均通过HEARTSTRING装置完成。
患者的平均年龄为67 + 9.7岁，预测死亡率为5.2%（逻辑欧洲心脏手术风险评估系统），观察到的死亡率为1.9%。15%的患者有术前神经功能障碍或脑血管疾病史。术后中风的总体发生率为0.48%，而根据中风风险评分应为1.3%。
根据先前发表的数据，我们的结果表明，在OPCAB期间避免主动脉侧钳夹可降低术后中风发生率。HEARTSTRING装置是创建近端主动脉吻合的一种安全选择。
