Long-Term Follow-Up of Device-Assisted Clampless Off-Pump Coronary Artery Bypass Grafting Compared with Conventional On-Pump Technique

Abstract

Study objective: To evaluate the long-term outcomes of clampless off-pump coronary artery bypass grafting (C-OPCAB) compared with conventional on-pump double clamping coronary artery bypass grafting (C-CABG). Methods: From October 2006 to December 2011, 366 patients underwent isolated coronary artery bypass grafting. After propensity score matching of preoperative variables, 143 pairs were selected who received C-OPCAB with the use of device-assisted PAS-Port proximal venous graft anastomoses or C-CABG, performed by the same surgeon experienced in both techniques. Data of the two groups of patients were retrospectively analyzed up to 14 years of follow-up. Results: As compared with C-OPCAB, in the C-CABG patients, the performed number of grafts per patient was higher (2.9 ± 0.5 vs. 2.6 ± 0.6, p-value 0.0001). At 14 years, overall survival, including in-hospital death, was 64 ± 4.7% for the C-OPCAB vs. 55 ± 5.5% for the C-CABG, freedom from overall MACCEs 51 ± 6.2% vs. 41 ± 7.7%, and from late cardiac death 94 ± 2.4% vs. 96 ± 2.2% (p-value not significant, for all comparisons). No significant statistical differences were observed in the actual rates of adverse events during follow-up. Independent predictors of survival were advanced age at operation (p-value 0.001) and a lower mean value of preoperative left ventricular ejection fraction (p-value 0.015). Conclusions: Our single-center study analysis suggests that clampless OPCAB using device-assisted proximal anastomoses proved to be not inferior to double-clamping CABG in the long-term follow-up, provided that involved surgeons are familiar with both techniques. These conclusions are supported by a large and long-term follow-up period, eliminating potential bias, i.e., by means of the propensity score matching and analyzing single-surgeon experience.

A Single-Center Experience in Low Ejection Fraction Coronary Artery Bypass Surgery

“…For example, a study by Youn et al found no signifcant diference in cardiac mortality between the two procedures during a long-term follow-up in patients with reduced EF (≤35%) [30]. Similarly, a recent study by Bassano et al reported similar results, highlighting the equivalent 14-year cardiac mortality outcomes between OPCAB and ONCAB surgeries [33]. Other studies have reported similar fndings between the two groups [30,[34][35][36][37].…”

Anaortic off-pump coronary artery surgery as a primary strategy to reduce the risk of neurological complications

“…We read with great interest the article by Seco and colleagues [1] based on their experience with the anaortic off-pump coronary artery bypass grafting (CABG), addressing the main advantages based on avoiding manipulation of the ascending aorta and achieving complete revascularization using multiple arterial grafts. Avoiding manipulation of the aorta has the rationale of reducing the risk of neurological complications, especially in high-risk patients affected preoperatively by previous ischemic stroke and or severe carotid artery atherosclerotic disease.…”