To explore surgical strategies that reduce perioperative neurologic complications in cardiovascular surgery, with the aim of improving perioperative outcomes and quality of life while reducing the socioeconomic burden. Specifically:
This multicenter, randomized controlled clinical trial will evaluate the benefits of a novel aortic no-touch technique in reducing perioperative silent brain infarction(SBI) among patients undergoing surgical treatment for coronary artery disease. The findings are expected to provide a safe and effective myocardial revascularization strategy for individuals at high risk of cerebral ischemia.
Adult patients (>18 years old) with multivessel coronary artery disease who are scheduled to undergo isolated off-pump coronary artery bypass grafting and who provide informed consent to participate in this study.
Indications for cardiopulmonary bypass surgery (or no contraindications to on-pump surgery);
Great saphenous vein is unsuitable for use as a graft conduit;
Subclavian artery stenosis or occlusion, or any contraindication to the use of the internal mammary artery as a graft conduit;
History of previous cardiac surgery;
Parallel
Aortic no-touch coronary artery bypass grafting (RIMA-SVG)
Procedure/SurgeryAscending aortic no-touch CABG with saphenous vein graft (SVG) anastomosed to the right internal mammary artery (RIMA)
Conventional off-pump CABG with partial clamping of the ascending aorta (Ao-SVG)
Procedure/SurgeryOff-pump CABG with proximal saphenous vein graft (SVG) anastomoses constructed on the ascending aorta using a partial-occlusion (side-biting) clamp.
Saphenous vein graft (SVG) occlusion rate
Assessed by coronary computed tomography angiography (CCTA)
New-onset clinical stroke and silent brain infarction (SBI)
Clinical stroke and SBI assessed at 7 ± 3 days postoperatively; SBI assessed by brain magnetic resonance imaging (MRI).
Incidence of postoperative delirium
The incidence of delirium evaluated by CAM/CAM-ICU
Incidence of perioperative neurocognitive disorder (PND)
Cognitive function will be assessed using the Montreal Cognitive Assessment (MoCA). Montreal Cognitive Assessment (MoCA; range 0-30 points, higher scores indicate better cognitive function).
Perioperative major adverse cardiovascular and cerebrovascular events (MACCE)
Major adverse cardiovascular and cerebrovascular events are defined as the composite of all-cause death, myocardial infarction, stroke and repeat revascularization.
MACCE within 3 months after surgery
Major adverse cardiovascular and cerebrovascular events are defined as the composite of all-cause death, myocardial infarction, stroke and repeat revascularization.
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