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Towards stroke-free coronary surgery: the role of the anaortic off-pump bypass technique
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  • Fabio Ramponi,
  • Michael Seco,
  • John Brereton ,
  • Mario Gaudino,
  • John D. Puskas,
  • Antonio Calafiore,
  • Michael Vallely
Fabio Ramponi
The University of Sydney School of Medicine
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Michael Seco
The University of Sydney School of Medicine
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John Brereton
Royal North Shore Hospital
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Mario Gaudino
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
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John D. Puskas
Mount Sinai Morningside Hospital
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Antonio Calafiore
John Paul II Foundation for Research and Treatment
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Michael Vallely
The Ohio State University Wexner Medical Center
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Abstract

Coronary artery and cerebrovascular disease represent a major cause of cardiovascular morbidity and mortality worldwide. Despite technological advancements in percutaneous interventions, surgical revascularization remains the preferred strategy in patients with left main or multivessel disease and in those with complex lesions with high SYNTAX score. As a result, an increasing number of older patients with diffuse atherosclerotic extracoronary disease are referred for coronary artery bypass grafting (CABG). Cerebrovascular complications after isolated coronary surgery occurs in 1-5% of patients; the magnitude of injury ranges from overt neurologic lesions with varying degree of permanent disability to “asymptomatic” cerebral events detected by dedicated neuro-imaging, nevertheless associated with significant long term cognitive and functional decline. Thromboembolic events due to manipulation of an atherosclerotic aorta are universally recognized as the leading etiology of early postoperative stroke following CABG. Coronary bypass surgery performed on an arrested heart relies on considerable aortic instrumentation associated with significant atheroembolic risk especially in older patients presenting with diffuse aortic calcifications. Surgical techniques to deal with a calcified ascending aorta during isolated coronary surgery have evolved over the last forty years. Moving away from aggressive aortic debridement or replacement, surgeons have developed strategies aimed to minimize aortic manipulation: from pump-assisted beating heart surgery with the use of composite grafts to complete avoidance of aortic manipulation with “anaortic” off-pump coronary artery bypass grafting, a safe and effective approach in significantly reducing the risk of intraoperative stroke.

Peer review status:Published

14 Nov 2020Submitted to Journal of Cardiac Surgery
16 Nov 2020Submission Checks Completed
16 Nov 2020Assigned to Editor
16 Nov 2020Reviewer(s) Assigned
23 Nov 2020Review(s) Completed, Editorial Evaluation Pending
23 Nov 2020Editorial Decision: Revise Minor
06 Jan 20211st Revision Received
07 Jan 2021Submission Checks Completed
07 Jan 2021Assigned to Editor
07 Jan 2021Reviewer(s) Assigned
13 Jan 2021Review(s) Completed, Editorial Evaluation Pending
13 Jan 2021Editorial Decision: Accept
27 Jan 2021Published in Journal of Cardiac Surgery. 10.1111/jocs.15372