Coronary artery bypass grafting (CABG) has consolidated its role as the most effective procedure for treating patients with advanced atherosclerotic
coronary artery disease, reducing the long-term risk of
myocardial infarction and death compared to other
therapies and relieving angina. Despite the recognized benefits afforded by surgical
myocardial revascularization, a subset of higher-risk patients bears a more elevated risk of perioperative
stroke.
Stroke remains the drawback of conventional CABG and has been strongly linked to aortic manipulation (cannulation, cross-clamping, and side-biting clamping for the performance of proximal aortic anastomoses) and the use of
cardiopulmonary bypass. Adoption of off-pump CABG (OPCAB) is demonstrated to lower the risk of perioperative
stroke, as well as reducing the risk of short-term mortality,
renal failure,
atrial fibrillation,
bleeding, and length of intensive care unit stay. However, increased risk persists owing to the need for the tangential ascending aorta clamping to construct the proximal anastomosis. The concept of anaortic (aorta no-touch) OPCAB (anOPCAB) stems from eliminating ascending aorta manipulation, virtually abolishing the risk of
embolism caused by aortic wall debris into the brain circulation. The adoption of anOPCAB has been shown to further decrease the risk of postoperative
stroke, especially in higher-risk patients, entailing a step forward and a refinement of outcomes provided by the primeval OPCAB technique. Therefore, anOPCAB has been the recommended technique in patients with
cerebrovascular disease and/or calciļ¬cation or
atheromatous plaque in the ascending aorta and should be preferred in patients with high-risk factors for neurological damage and
stroke.