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With off-pump coronary artery bypass (OPCAB) surgery, the rhythm of life never stops.

OPCAB: Reduce the risk of stroke due to micro emboli

One of the principle causes of stroke associated is the occurrence of micro emboli—tiny particles of plaque—breaking off from a vessel and entering the bloodstream where they can become lodged in the brain. The risk of stroke and cognitive dysfunction is greater with conventional bypass surgery compared with the beating heart (OPCAB) procedure. It has been documented that the use of clamps to close off blood flow through the aorta during the surgery is responsible for the release of these particles into the bloodstream.[10] [11] [12] By eliminating the clamp, surgeons can minimize aortic manipulation and therefore reduce the risk of neurological complications.[13]

Getinge Acrobat-i Positioner

OPCAB with the ACROBAT system – Helping to reduce clamp use in CABG surgery

In conventional CABG surgery, in order to place the patient on the heart-lung machine, two main clamps are used: a cross clamp and a partial occlusion clamp.

In OPCAB surgery, the cross clamp is not needed. While some physicians may use the partial occlusion clamp to create a bloodless field when suturing a graft onto the aorta, there are alternatives to using clamps altogether that enable physicians to maximize the benefits of OPCAB.

Heartstring III Proximal Seal System

Eliminate aortic clamps. Reduce the risk in CABG surgery.

The Heartstring III Proximal Seal System eliminates the need for an aortic clamp during CABG surgery. This reduces the risk of cerebral emboli, and potentially improves patient neurocognitive outcomes.

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  1. 1. Sedrakyan A, et al. Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting: a meta-analysis of systematically reviewed trials. Stroke. 2006 Nov;37(11):2759-69.

  2. 2. Puskas JD, et al. Off-Pump coronary artery bypass grafting provides complete revascularization while reducing myocardial injury, transfusion requirements and length of stay: prospective randomized comparison of 200 unselected patients having OPCAB verses conventional CABG. J Thorac Cardiovasc Surg. 2003;125:797-808.

  3. 3. Stamou SC, et al. Stroke after conventional versus minimally invasive coronary artery bypass. Ann Thorac Surg. 2002;74:394-399.

  4. 4. Van Dijk D, et al. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation. 2001 Oct 9;104(15):1761-6.

  5. 5. Puskas J, Cheng D, Knight J, et al. Off-pump versus conventional coronary artery bypass grafting: a meta-analysis and consensus statement from the 2004 ISMICS Consensus Conference. Innovations. 2005;1:3-27.

  6. 6. Ascione R, Angelini GD. OPCAB surgery: a voyage of discovery back to the future. Eur Heart J. 2003;24:121-124.

  7. 7. Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet. 2002;359:1194-1199.

  8. 8. Demers P, et al. Multivessel Off-Pump Coronary Artery Bypass Surgery In The Elderly. Eur J Cardiothorac Surg. 2001 Nov;20(5):908-12.

  9. 9. Mack MJ, et al. On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in a Matched Sample of Women: A Comparison of Outcomes. Circulation. 2004 Sep 14;110(11 Suppl 1):II1-6.

  10. 10. Barbut D. et al. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke. 1994 Dec;25(12):2398-402.

  11. 11. Pugsley W, et al. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke. 1994 Jul;25(7):1393-9.

  12. 12. Barbut D, et al. Impact of embolization during coronary artery bypass grafting on outcome and length of stay. Ann Thorac Surg. 1997 Apr;63(4):998-1002.

  13. 13. El Zayat H, et al. Avoiding the clamp during off-pump coronary artery bypass reduces cerebral embolic events: results of a prospective randomized trial. Interact Cardiovasc Thorac Surg. 2012 Jan;14(1):12-6.