Stroke and ON-Pump Coronary Artery Bypass Grafting. Should We Change to OFF-Pump? Our Experience from the North of Jordan.

PRINCIPLES: Stroke is a well known complication after coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB). We were interested in reviewing our experience with on-pump coronary artery bypass grafting, to evaluate its neurologic dysfunction and its impact on patient management. And to ask a question that recently applied. Should we change to OFFPump?MATERIAL AND METHODS: A retrospective review of 1.050 patients undergoing elective coronary artery bypass grafting (CABG) was performed from May 5, 2003, to December 31, 2007, in our institution. Stroke was defined as any new permanent global or focal neurological deficit, immediately after extubation (early) or within 5-6 day in the hospital (late). Medline literature was searched for all the studies published in the English language between 1999 and 2006 reporting neurological complications on patients undergoing CABG with emphasis on comparisons between off-pump coronary artery bypass surgery (OPCAB) and CPB techniques. The following terms were used: Stroke and on-pump coronary artery bypass grafting; on-pump versus off-pump; brain injury after coronary artery bypass grafting.RESULTS: Stroke occurred in 19 patients (1.81%). From this group thirteen were female (68.42%). Fifteen patients were diabetic (78.95%). History of previous transient ischemic attacks was found in 14 patients (73.68%). CONCLUSIONS: Female sex, diabetic patients and patients with previous transient ischemic attacks are associated with increased the risk of stroke and in-hospital mortality. Prospectively randomised trial is needed to give us a proper answer on our question.