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J Thorac Cardiovasc Surg 2006;132:209
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

John W. Hammon, MD

Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1096

(Email: jhammon{at}wfubmc.edu).

The authors of our article thank Omer Ashraf for his comments relating to our published article. We thank him for his careful reading and analysis.

Ashraf makes the comment that it was invalid to compare the multiple clamping group with the single clamping group and the off-pump coronary artery bypass group because the group is significantly older. As we stated in the "Discussion" section, we have performed additional analyses on patients in all 3 groups who were older than the age of 65 years and found that the multiple clamping group still had a statistically greater number of neurocognitive deficits at 3 and 6 months, thus invalidating this criticism. There was no significant difference between the incidence of hyperlipidemia or atrial fibrillation in all 3 groups.

Relating to late neuropsychologic testing, as mentioned by Ashraf, in our experience deficits that occur after 6 months often appear in a new domain and thus might represent a new brain lesion, usually related to spontaneous atherosclerotic emboli.

Our analysis of the literature would suggest that the question of better neurological or neurpsychologic outcomes with OPCAB surgery has evidenced no clear difference, as did this study. Evidence from our institution would also suggest that the more applications of aortic clamps, cannulas, or proximal anastomoses, the greater number of emboli. The temperature at which those emboli reach the brain is also important in determining outcome.

We thank Ashraf for his comments and appreciate the time spent on the article.


Related Article

Is it really the number of clamps that is responsible for worse postbypass neurological outcomes?
Omer Ashraf
J. Thorac. Cardiovasc. Surg. 2006 132: 208-209. [Extract] [Full Text] [PDF]




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