Stroke Risk After On-Pump Minimally Invasive Multivessel Coronary Artery Bypass Grafting With Right Axillary Artery Cannulation and Preoperative Computed Tomography Angiography
Abstract
Objectives: Stroke remains a major concern in on-pump minimally invasive coronary artery bypass grafting (CABG), particularly when peripheral arterial cannulation and aortic manipulation are required in patients with systemic atherosclerosis. This study evaluated stroke outcomes after total coronary revascularization via left anterior thoracotomy (TCRAT) with preoperative computed tomography angiography (CTA) and right axillary artery (RAA) cannulation.
Methods: A total of 800 consecutive patients undergoing isolated non-emergent multivessel minimally invasive CABG were analysed. All procedures were performed on cardiopulmonary bypass with RAA cannulation, transthoracic aortic cross-clamping, cardioplegic arrest, cardiac slinging manoeuvres, and side-bite clamping for proximal anastomoses. Of these, 85.4% were male; median age was 67.0 years (interquartile range 13.0), and median EuroSCORE II was 2.0 (interquartile range 2.1). All patients underwent preoperative CTA. Stroke events were analysed by timing, distribution, and presumed mechanism.
Results: The overall in-hospital rate of major adverse cardiac and cerebrovascular events was 1.9%. In-hospital mortality was 1.0%, myocardial infarction 0.4%, repeat revascularization 0.6%, and stroke 0.6%. All strokes were ischaemic. Two strokes (0.25%) occurred within 72 hours and were considered procedure-related, whereas 3 (0.37%) occurred after 72 hours and were associated with postoperative atrial fibrillation or advanced intracranial atherosclerosis.
Conclusions: In patients undergoing minimally invasive on-pump multivessel CABG after preoperative CTA confirmed suitable anatomy for transthoracic clamping and planned aortic manipulation, a standardized TCRAT strategy with RAA cannulation was associated with a low rate of clinically apparent in-hospital stroke. These findings support the feasibility and clinical rationale of this approach in routine practice, while comparative studies are required to define its independent effect on stroke prevention.
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BibTeX
@article{sellin2026stroke,
title = {{Stroke Risk After On-Pump Minimally Invasive Multivessel Coronary Artery Bypass Grafting With Right Axillary Artery Cannulation and Preoperative Computed Tomography Angiography}},
author = {Christian Sellin and Hilmar Dörge and Marius Grossmann and Alexandru Durutya and Ardawan Rastan and Niki Tabesh and Volodymyr Demianenko},
journal = {Interdisciplinary Cardiovascular and Thoracic Surgery},
year = {2026},
month = sep,
doi = {10.1093/icvts/ivag257},
url = {https://doi.org/10.1093/icvts/ivag257},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stroke Risk After On-Pump Minimally Invasive Multivessel Coronary Artery Bypass Grafting With Right Axillary Artery Cannulation and Preoperative Computed Tomography Angiography
AU - Christian Sellin
AU - Hilmar Dörge
AU - Marius Grossmann
AU - Alexandru Durutya
AU - Ardawan Rastan
AU - Niki Tabesh
AU - Volodymyr Demianenko
PY - 2026
DA - 2026/09/15
JO - Interdisciplinary Cardiovascular and Thoracic Surgery
DO - 10.1093/icvts/ivag257
UR - https://doi.org/10.1093/icvts/ivag257
AB - Objectives: Stroke remains a major concern in on-pump minimally invasive coronary artery bypass grafting (CABG), particularly when peripheral arterial cannulation and aortic manipulation are required in patients with systemic atherosclerosis. This study evaluated stroke outcomes after total coronary revascularization via left anterior thoracotomy (TCRAT) with preoperative computed tomography angiography (CTA) and right axillary artery (RAA) cannulation. Methods: A total of 800 consecutive patients undergoing isolated non-emergent multivessel minimally invasive CABG were analysed. All procedures were performed on cardiopulmonary bypass with RAA cannulation, transthoracic aortic cross-clamping, cardioplegic arrest, cardiac slinging manoeuvres, and side-bite clamping for proximal anastomoses. Of these, 85.4% were male; median age was 67.0 years (interquartile range 13.0), and median EuroSCORE II was 2.0 (interquartile range 2.1). All patients underwent preoperative CTA. Stroke events were analysed by timing, distribution, and presumed mechanism. Results: The overall in-hospital rate of major adverse cardiac and cerebrovascular events was 1.9%. In-hospital mortality was 1.0%, myocardial infarction 0.4%, repeat revascularization 0.6%, and stroke 0.6%. All strokes were ischaemic. Two strokes (0.25%) occurred within 72 hours and were considered procedure-related, whereas 3 (0.37%) occurred after 72 hours and were associated with postoperative atrial fibrillation or advanced intracranial atherosclerosis. Conclusions: In patients undergoing minimally invasive on-pump multivessel CABG after preoperative CTA confirmed suitable anatomy for transthoracic clamping and planned aortic manipulation, a standardized TCRAT strategy with RAA cannulation was associated with a low rate of clinically apparent in-hospital stroke. These findings support the feasibility and clinical rationale of this approach in routine practice, while comparative studies are required to define its independent effect on stroke prevention.
SN - 2753-670X
ER -