Post-CABG CVA in the Era of Single Aortic Clamp and Arterial Revascularization

Background:
According to the Syntax study, CVA occurred in 2.2% of patients during 30-days post-CABG, and rates spiked to an alarming 3.7% five years after surgery. This excessive rate, compared to patients treated with PCI, was alarming and practically does not reflect its real incidence in our daily practice.

Surgeons today are able to achieve better clinical results and lower rates of CVA, by using in situ bilateral internal thoracic arteries to minimize the number of proximal anastomosis, and avoiding the use of the side-biting clamp.

Methods:
We reviewed 1255 patients with a multi vessel CAD who underwent CABG surgery, and followed them for up to 10 years. All patients had an intermediate or high Syntax score.

CVA was defined as permanent neurological damage, and data of risk factors, severity of the cardiac disease and operative procedure were collected.

Interestingly, only 12.2% of our patients were woman. The average age was 60 years (range 42-83). Risk factors included Diabetes mellitus (40%), Hypertension (67%) and PVD (7 %).

Results:
A ten years follow-up revealed actuarial survival rates of 97.4%, 92.35%, and 90%, after 1, 5 and 10 years, respectively.

During 30 days after surgery, 0.8% of patients had a CVA (compared to 0.6% in PCI-treated patients in the Syntax study), and 3.9% of patients after 5 years.

Conclusions:
Our encouraging results are in part thanks to a change in surgical practice, designated to reduce aortic manipulation during surgery, and are concordant with other studies, which demonstrate this method`s advantage in reducing neurological complications.