Our Summary

This research study aimed to understand the impact of two different types of heart bypass surgery - on-pump and off-pump - on patients who had a history of stroke or transient ischemic attack (a mini-stroke).

The study involved 414 patients who had the surgery between January 2015 and September 2018. Of these, 295 had the on-pump surgery and 119 had the off-pump surgery. The researchers were particularly interested in observing the occurrence of stroke or delirium (a state of confusion) after the surgery, as well as any other major adverse neurological events.

The results showed that patients who had off-pump surgery were less likely to suffer from stroke or delirium after the operation. Also, the overall occurrence of adverse neurological events was lower in the off-pump group.

So, the study concludes that patients with a history of stroke or mini-stroke might benefit more from off-pump heart bypass surgery, as it seems to reduce the risk of post-surgery neurological complications.

FAQs

  1. What was the primary focus of this research study on heart bypass surgery?
  2. What were the key findings of the study regarding the impact of on-pump and off-pump surgery on patients with a history of stroke or mini-stroke?
  3. Based on the study, which type of heart bypass surgery is potentially more beneficial for patients with a history of stroke or mini-stroke?

Doctor’s Tip

A helpful tip a doctor might give a patient about CABG is to discuss the option of off-pump surgery if they have a history of stroke or transient ischemic attack. This type of surgery may reduce the risk of post-surgery neurological complications such as stroke or delirium. It is important to have a thorough discussion with your healthcare provider about the best approach for your individual situation.

Suitable For

Patients who are typically recommended for coronary artery bypass grafting (CABG) include those with significant blockages in their coronary arteries that cannot be managed with medication or less invasive procedures such as angioplasty or stenting. Patients who have severe symptoms of coronary artery disease, such as chest pain (angina) that significantly affects their quality of life or limits their ability to perform daily activities, may also be recommended for CABG.

Other factors that may indicate a need for CABG include:

  • Multiple blockages in the coronary arteries
  • Left main coronary artery disease
  • Diabetes
  • Previous heart attack
  • Reduced heart function
  • Unstable angina
  • Failure to respond to medical treatment

Ultimately, the decision to recommend CABG is based on a thorough evaluation of the patient’s medical history, symptoms, and the severity of their coronary artery disease. Each patient is unique, and the decision to undergo CABG should be made in consultation with a cardiac surgeon and other members of the healthcare team.

Timeline

Before CABG:

  • Patient experiences symptoms of coronary artery disease, such as chest pain or shortness of breath
  • Patient undergoes diagnostic tests, such as a stress test or cardiac catheterization, to determine the extent of blockages in the coronary arteries
  • Patient and their healthcare team decide that CABG is the best treatment option
  • Patient undergoes pre-operative tests and evaluations to assess their overall health and fitness for surgery

After CABG:

  • Patient undergoes the CABG surgery, where a healthy blood vessel is taken from another part of the body and used to bypass the blocked coronary artery
  • Patient is monitored closely in the intensive care unit (ICU) immediately after surgery
  • Patient is transferred to a regular hospital room once stable
  • Patient undergoes cardiac rehabilitation to help with recovery and improve heart health
  • Patient is monitored for any complications, such as infection or blood clots, in the weeks and months following surgery
  • Patient follows up with their healthcare team regularly to monitor their heart health and make any necessary lifestyle changes to prevent further blockages in the arteries

What to Ask Your Doctor

Some questions a patient should ask their doctor about CABG include:

  1. What are the potential risks and benefits of on-pump versus off-pump heart bypass surgery for someone with a history of stroke or transient ischemic attack?
  2. How does my personal medical history and current condition influence the decision between on-pump and off-pump surgery?
  3. What are the potential long-term outcomes and recovery differences between on-pump and off-pump surgery for someone with a history of stroke?
  4. Are there any specific considerations or precautions I should take before and after the surgery, given my history of stroke or mini-stroke?
  5. How will you monitor and manage the risk of stroke or delirium during and after the surgery, especially in light of my previous neurological events?
  6. Is there any additional testing or evaluation that should be done to assess my specific risk factors and determine the most appropriate type of heart bypass surgery for me?
  7. What is the success rate and potential complications associated with on-pump and off-pump surgery in patients with a history of stroke?
  8. How will you work with other specialists, such as neurologists, to ensure the best possible outcome for me during and after the surgery?
  9. Are there any lifestyle changes or medications I should consider to reduce my risk of stroke or other neurological complications following the surgery?
  10. Can you provide more information or resources for me to better understand the differences between on-pump and off-pump heart bypass surgery and how it may impact my specific situation?

Reference

Authors: Dominici C, Salsano A, Nenna A, Spadaccio C, El-Dean Z, Bashir M, Mariscalco G, Santini F, Chello M. Journal: J Card Surg. 2019 Oct;34(10):941-947. doi: 10.1111/jocs.14158. Epub 2019 Jul 3. PMID: 31269312