ABSTRACT 31

FURTHER REDUCTION IN STROKE FOLLOWING OFF-PUMP CORONARY ARTERY BYPASS GRAFTING--A 10 YEAR EXPERIENCE

Naresh Trehan , Manisha Mishra , Ravi R Kasliwal
Escorts Heart Institute and Research Centre, New Delhi-110025, India

BACKGROUND: Perioperative stroke is a devastating complication following CABG. The reported incidence of neurological complications following conventional CABG is 3-7%. With improved monitoring and surgical techniques we have been able to achieve a drastic reduction in the stroke rate in our institution. This study evaluates the incidence of neurological sequelae in the off-pump group of CABGs.

METHODS: Over a ten year period from January 1990 to September 2000, off-pump coronary artery bypass surgery (OPCAB) was performed on 2800 patients of the 18037 patients undergoing CABG during that time frame at the Escorts Heart Institute and Research Centre. Initially OPCAB was performed selectively in the high risk group of patients (atheromatous aorta, renal impairment, COPD, octogenarians etc). Lately we have been performing multivessel OPCABs electively in about 60-65% of the patients undergoing CABG.

RESULTS: Mean age of the patients was 58.0±9.91 (27-85 years), mean number of grafts was 2.9 per patient. Neurological complications (stroke/TIA) occurred in 0.14 % of patients

Over all hospital mortality in OPCAB patients was 2.14%, while mortality from neurological complications was 0.07%. Predicted mortality (Parsonett) for the entire patient group was 14.4% (p<0.001)..

CONCLUSION: Although current techniques of monitoring and surgery have significantly reduced the risk of stroke from CABG. Our data strongly supports OPCAB as a technique to further reduce stroke following CABG, especially in the high risk group of patients.