Effects Of Carotid Artery Stenosis With Different Degrees On Postoperative Neurological Complications In Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Objective: To investigate the effect of carotid artery stenosis with different degrees on postoperative neurological complications after off-pump coronary artery bypass grafting(OPCABG),and to indentify the independent risk factors of neurological complications after OPCABG.Methods:A total of 1185 patients undergoing OPCABG were retrospectively included.Patients were divided into three groups based on the degree of carotid artery stenosis: no significant carotid artery stenosis(<50%),moderate stenosis(50%-70%)and severe stenosis(>70%).The patients were divided into two subgroups according to the medical records of whether carotid artery stenosis intervention performed before OPCABG.All interventions occurred in the severe artery stenosis group.Carotid artery stenosis intervention measures included carotid artery stenting(CAS)before operation and carotid endarterectomy(CEA)during OPCABG.Chi-square test was used to analyze the effect of different degrees of carotid artery stenosis on postoperative neurological complications undergoing OPCABG.Chi-square test was used to indentify the effect of carotid artery intervention on postoperative neurological complications in patients with severe carotid artery stenosis after OPCABG.The preoperative factors included sex,age over 65 years,hypertension,diabetes,hyperlipidemia,preoperative cardiac arrhythmia,preoperative myocardial infarction,carotid artery stenosis,preoperative cerebral infarction,and presence of left main coronary stenosis.Intraoperative factors included intraoperative emergency cardiopulmonary bypass(CPB),the number of coronary artery bypass grafts?3,carotid artery revascularization.Postoperative factors included postoperative arrhythmia,reoperative thoracotomy for hemostasis.These factors were collected.Multivariate logistic regression analysis was used to identify independent risk factors for neurological complications after OPCABG.Results: 1.Among 1185 patients,1038 had no significant carotid artery stenosis,74 had moderate and 73 had severe carotid artery stenosis.The results showed that the incidence of neurological complications after OPCABG in patients with mild,moderate and severe carotid stenosis was 2.7%,6.8% and 8.2%.With the increasing severity of carotid artery stenosis,neurological complications after OPCABG increased.And the difference was statistically significant(P<0.05).2.In the severe carotid artery stenosis group,the incidence of postoperative neurological complications in the carotid artery intervention subgroup(6.9%)was lower than that in the non-intervention subgroup(9.1%).But the result of chi-square test was not statistically significant(P >0.05).3.Multivariate logistic analysis showed that hypertension,diabetes,preoperative cerebral infarction,carotid artery stenosis,intraoperative emergency CPB,postoperative arrhythmia,and reoperative thoracotomy for hemostasis were independent risk factors of postoperative neurological complications after OPCABG.Sex,age over 65 years old,preoperative arrhythmia,preoperative myocardial infarction,presence of left main coronary stenosis,the number of coronary artery bypass grafts?3,and carotid artery intervention were not independent risk factors for postoperative neurological complications.Conclusions:1.This study indicates that carotid artery stenosis may be an influencing factor.2.The carotid artery intervention may not decrease the occurrence of postoperative neurological complications after OPCABG in the severe stenosis group.3.Hypertension,diabetes,preoperative cerebral infarction,intraoperative emergency CPB,postoperative arrhythmia,and reoperative thoracot omy for hemostasis are independent risk factors of postoperative neurological complications after OPCABG.