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J Thorac Cardiovasc Surg 2005;129:307-313
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

No-touch aorta off-pump coronary surgery: The effect on stroke

^a Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
^b Department of Epidemiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Received for publication March 24, 2004; revisions received May 21, 2004; accepted for publication June 4, 2004.

^* Address for reprints: Oren Lev-Ran, MD, Department of Cardiothoracic Surgery, The Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 64239, Israel (E-mail: orenlevran{at}hotmail.com).

OBJECTIVE: Studies examining the neuroprotective effects of off-pump coronary artery bypass grafting have shown inconsistent results. Most studies, however, have not differentiated between clampless and clamp off-pump techniques. The aim of this study was to evaluate the effect of avoiding aortic manipulation on major neurologic outcomes after off-pump coronary artery bypass grafting.

METHODS: A total of 700 consecutive patients undergoing multiple-vessel off-pump coronary artery bypass grafting between 2000 and 2003 were included. The 429 patients undergoing aortic no-touch technique were compared with 271 patients in whom partial aortic clamps were applied. The aorta was screened by manual palpation, and epiaortic ultrasonography was used selectively.

RESULTS: The frequency of detected atherosclerotic aortic disease was higher in the no-touch group (17.4% vs 5.1%, P < .0001). No-touch revascularization was achieved with arterial conduits, arranged in T-graft or in situ configurations (50%). The respective graft/patient ratios were 2.5 ± 0.6 and 2.6 ± 0.6 in the side-clamp and no-touch groups (P = .009); however, revascularization of the posterolateral myocardial territory was comparable (87% vs 90%, difference not significant). The incidence of stroke (0.2% vs 2.2%, P = .01) was significantly lower in the no-touch group (1/429). Logistic regression identified partial aortic clamping as the only independent predictor of stroke (odds ratio 28.5, confidence interval 0.22-333, P = .009), increasing this risk 28-fold. Peripheral vascular disease (P = .068), diabetes (P = .072), and history of stroke (P = .074) trended toward stroke.

CONCLUSIONS: Avoiding partial aortic clamping during off-pump coronary artery bypass grafting provides superior neurologic outcome. The results are reproducible and irrespective of the severity of aortic disease or the method of aortic screening. This technique is recommended whenever technically feasible.

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