Use of Blood Products and Diseased Ascending Aorta Are Determinants of Stroke After Off-Pump Coronary Artery Bypass Grafting

ObjectiveTo examine the effect of blood products on the occurrence of stroke after coronary artery surgery.DesignInstitutional retrospective analysis.SettingUniversity hospital.ParticipantsOne thousand three hundred fourteen patients undergoing coronary artery surgery.InterventionsOff-pump coronary artery bypass grafting (OPCAB). Epiaortic ultrasound was performed in all patients.Measurements and Main ResultsComplete pre-, intra- and postoperative data including the number of transfused blood products as well as the timing, type, and course of stroke were available in all patients. Postoperative stroke occurred in 23 patients (1.8%). Logistic regression identified transfusion of platelets (3.6% v 1.1%, p = 0.003, OR 3.34, 95%CI 1.46-7.67) and diseased ascending aorta (3.0% v 1.2%, p = 0.022, OR 2.64, 95% CI 1.15-6.06) as independent predictors of stroke. When these variables were adjusted for CHA2DS2VASc (p = 0.005, OR 1.44, 95% CI 1.12-1.86), only transfusion of platelets (p = 0.012, OR 2.91, 95% CI 1.26-6.70) was associated with stroke. Neither nadir hematocrit on the day of surgery nor nadir hematocrit during the perioperative period was an independent predictor of stroke. Chi-squared automatic interaction detection analysis identified solvent/detergent-treated plasma (Octaplas; Octapharma AG, Lachen, Switzerland) units>2 and platelet units>4 along with diseased ascending aorta as independent predictors of stroke. The stroke rate was 8.9% in patients receiving>2 units of Octaplas and having a diseased ascending aorta. In patients receiving≤2 units of Octaplas, the stroke rate was as high as 3.8% in patients receiving>4 units of platelets.ConclusionsThe results of this study indicated that atherosclerosis of the ascending aorta as well as transfusion of platelets and/or Octaplas were independent predictors of stroke after OPCAB.