Clampless off-pump heart surgery reduces stroke in patients with coronary artery disease.

This study compared the effect of two different heart surgery techniques on reducing stroke and other complications among patients with coronary artery disease. 

The heart supplies blood to the entire body, but it also needs to receive its own blood supply to function. The arteries that supply the heart with blood are called coronary arteries. The left and right main coronary arteries supply blood, oxygen and nutrients to the left and right sides of the heart. Coronary artery disease occurs when there is a build up of fatty deposits in these arteries. This can cause blockage of blood flow to the heart and may lead to a heart attack.

Coronary artery disease can be treated with surgery, such as coronary artery bypass grafting (CABG – pronounced “cabbage”). During the surgery, a piece of healthy blood vessel is taken from the leg, arm, or chest and is connected, or grafted, to the blocked blood vessel so as to bypass the clogged artery. During most bypass surgeries, the heart is stopped and a heart-lung pump machine takes over the work of the heart and lungs. A different form of CABG is to perform the surgery without a pump (off-pump), commonly known as “off-pump coronary artery bypass” or OPCAB. With this surgery the heart is still beating while the grafts are put in place. One possible reason why OPCAB may be preferred is because the fatty deposits in the blocked artery are less likely to break loose during the surgery. These fatty depoits can travel to other parts of the body such as the brain, compromising blood flow to the brain and resulting in neurological damage or even stroke.

This study compared CABG and a form of OPCAB called clampless OPCAB, which is a further surgical step to reduce the risk of fatty deposits breaking loose. The study investigated the safety and effectiveness of the two groups at reducing stroke, mortality and other complications in patients undergoing surgery for left main coronary artery disease.

Data was collected over a ten-year period from patients with left main coronary artery disease who underwent heart surgery. 507 patients underwent clampless OPCAB, and 524 patients underwent conventional on-pump CABG. The occurrence of heart related complications such as stroke, mortality, and heart attack as well as cardiovascular non-related complications were compared between the two groups.

The study showed that patients with off-pump OPCAB had reduced occurrences of heart related complications (3%) and stroke (0.4%) in comparison to CABG surgery related heart complications (7.8%) and stroke (2.9%). Overall mortality was similar in both groups. Complications not heart-related were also decreased after OPCAB; 8.9% compared to 19.7% in CABG patients. 

This study concluded that clampless OPCAB reduces the risk of stroke, mortality and complications compared to standard CABG. 

One limitation to the study is that it was not a randomized control trial so information surrounding treatment selection or reporting of any complications may have been left out.