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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2007 December;48(6):773-9
Risk of retinal microembolism after off-pump and on-pump coronary artery bypass surgery
Rainio A. 1, Hautala N. 2, Pelkonen O. 3, Palosaari T. 2, Heikkinen J. 1, Mosorin M. 1, Lahtinen J. 1, Taskinen P. 1, Anttila V. 1, Surcel H.-M. 4, Lepojärvi M. 1, Juvonen T. 1, Biancari F. 1
1 Division of Cardio-thoracic and Vascular Surgery Department of Surgery Oulu University Hospital, Oulu, Finland
2 Department of Ophthalmology Oulu University Hospital, Oulu, Finland
3 Department of Radiology Oulu University Hospital, Oulu,Finland
4 National Health Institute, Oulu, Finland
Aim. In order to investigate the neuroprotective efficacy of off-pump coronary artery bypass surgery (OPCAB) over conventional on-pump coronary artery bypass surgery (CCAB), we have performed a prospective randomized study evaluating retinal circulation changes after OPCAB and CCAB.
Methods. Twenty patients were randomized to OPCAB or CCAB. Retinal fluorescein angiography and 60° black-and-white as well as color fundus photographs of both eyes of each patient were taken 1 to 24 h before and 5 to 6 days after the operation.
Results. Patients undergoing OPCAB had more severely stenosed carotid arteries (P=0.075), higher incidence of slightly diseased ascending aorta (P=0.087) and higher Northern New England Cardiovascular Study Group stroke risk score (P=0.075). Neither stroke nor transient ischemic attack occurred postoperatively in these patients. Inferotemporal retinal arterial embolization and microinfarction was detected in one patient after CCAB, but in none of the OPCAB group.
Conclusion. The risk of retinal embolism can be minimized by the use of OPCAB and, most likely, by adequate epiaortic ultrasound scanning of the ascending aorta and avoiding clamping in case of severely diseased aorta.