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Off Pump CABG and Stroke: Incidence and Mechanisms: A Single Center Experience

Vivek Wadhawa, Associate Professor, Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016, India. , Sudhir Adalti* , Vivek Wadhawa** , Vijay Gupta*** , Sanjay Patel****

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Journal of Cardiovascular Medicine and Surgery 3(2):p 161-166, Jul-Dec 2017. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.3217.13

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Abstract

Background: Perioperative stroke is a distressing complication and it can lead to severe debilitation and excess mortality [14]. Perioperative strokes are mostly ischemic and the occurrence of perioperative stroke was different in the existing studies and ranges from 0.5 to 4.5% [57]. OPCAB has been conveyed to propose an inferior risk of stroke [89]. However, there is unavailability of adequate information on the timing and mechanisms of perioperative stroke in the setting of OPCAB. The aim of the study was to assess the incidence and mechanisms of perioperative stroke after OPCAB. Methods and Materials: We designed a retrospective, observational study and enrolled 2375 patients operated for isolated OPCAB between January 2014 and December 2016. Perioperative stroke is distinct as a neurologic deficit of abrupt onset affected by a disturbance in cerebral blood supply (ischemic or hemorrhagic) that did not resolve within 24 hours after CABG and continued for more than 72 hours [10]. Perioperative stroke does not include the neurologic deficits of confusion, delirium, and (or) encephalopathic (anoxic or metabolic) events. Result: The incidence of stroke in our study was 1.01% (24 patients out of total 2375 patients suffered stroke). There were fifteen men and nine women with the median age of 64 years (range, 60 to 68 years).Fourteen patients had a history of stroke prior to surgery. All the patients had impaired left ventricular ejection fraction. Three fourths of our patients were diabetic and two thirds hypertensive. Almost half of our patients were in atrial fibrillation and had previous myocardial infarction and coexistent peripheral vascular disease. Conclusion: Stroke rate in present study is on lower side of the reported range of stroke incidence as reported in various studies. Risk factors that we identified in the present study are similar to other studies as well but owing to its observational nature, results cannot be generalized.

 

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.3217.13

Keywords

OPCAB; Stroke; CABG. 

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