Association Between Proximal Anastomotic Technique and Post-operative Stroke Following Coronary Artery Bypass Grafting.

INTRODUCTION

The relationship between aortic clamping technique and post-operative stroke after coronary artery bypass grafting (CABG) is debated. We aimed to assess whether proximal anastomotic technique was associated with post-operative stroke at our quaternary care institution.

METHODS

We retrospectively analyzed our single-center's prospectively maintained registry, identifying all first-time, isolated on-pump CABG cases from 2013 to 2023. Patients were stratified by aortic clamping technique into single cross clamp (SCC) and side-biting clamp (SBC) cohorts. Primary outcome of interest was occurrence of post-operative stroke within 30 d of operation. Standard univariate methods were used to analyze baseline, intra-operative, and post-operative variables. Inverse propensity weighted multivariable regression identified variables independently associated with stroke.

RESULTS

Among 1359 patients, 662 (48.7%) underwent SBC and 697 (51.3%) SCC. Stroke incidence was 29/1359 (2.1%). There were 14 strokes in the SBC cohort (2.1%) and 15 strokes in the SCC cohort (2.2%) (P = 0.999). On inverse-weighted multivariable analysis, history of cardiovascular accident (CVA) (OR 3.27, 95% CI 1.32-8.14, P = 0.011), peripheral arterial disease (PAD) (OR 2.41, 95% CI 1.22-4.76, P = 0.011), and transient ischemic attack (TIA) (OR 2.81, 95% CI 1.01-7.82, P = 0.048) were independently associated with post-operative stroke. SBC technique was not associated with stroke (OR 1.04, 95% CI 0.49-2.22, P = 0.913).

CONCLUSIONS

History of CVA, TIA, and PAD were independently associated with stroke after CABG. Post-operative stroke rates were similar between the SCC and SBC cohorts. We believe that careful patient selection and attention to aortic calcification is likely an important tool to mitigate peri-operative stroke risk.