New 'no-touch' CABG procedure reduces chance of stroke by 78%

A new study by researchers at the University of Sydney in Australia found that a new heart bypass surgical technique that requires no manipulation of heart vessels could reduce the chance of stroke by 78 percent.

The findings, published Feb. 28 in the Journal of the American College of Cardiology, included more than 37,000 patients. Researchers tested the “no-touch” surgical technique to determine how effectively it treated ischemic heart disease, according to a Feb. 28 press release.

The study was led by Michael P. Vallely, PhD, a cardiothoracic surgeon at Sydney Heart and Lung Surgeons and a professor at the University of Sydney. Other researchers included cardiothoracic surgeons from the U.S., Australia, Canada and the United Kingdom.

Compared to a standard coronary artery bypass grafting (CABG) procedure, which requires surgeons to stop the heart during surgery, place a clamp on the large vessel of the aorta and put the patients on a lung machine, the “no-touch” technique doesn’t require any of those steps. Using the less invasive technique, surgeons can perform the procedure on a beating heart, using a small stabilizer, eliminating the need to manipulate large heart vessels.

"Without aortic manipulation, whilst performed only by a minority of surgeons, has an important place in the higher risk patient undergoing CABG," Vallely said in a statement. “This powerful analysis demonstrates the potential benefit, not only in the reduction of stroke, but also in mortality... [and] provides the most comprehensive and highest-quality evidence currently available [to] help inform decisions regarding the management of these patients."

In addition to lowering the chance of stroke, the “no-touch” technique was found to reduce postoperative mortality by 50 percent, renal failure by 53 percent, bleeding by 48 percent, atrial fibrillation by 34 percent and the length of time a patient will spend in an intensive care unit by 13.3 hours. It’s also especially beneficial for elderly and high-risk patients since it’s less invasive than traditional CABG procedures.

In an accompanying editorial about the study, John G. Byrne, MD, chief medical officer at the Hospital Corporation of America, and Marzia Leacche, MD, a cardiothoracic surgeon at Spectrum Health, noted that the risk of stroke was directly related to the extent of aortic manipulation in the study.

"A no-touch technique is probably a superior approach compared to conventional on-pump CABG with aortic clamping... in patients with increased cerebrovascular disease or atherosclerotic disease in the aorta,” they wrote.