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

Carlo Bassano,Claudia Altieri,Giovanni Ruvolo,Fabio Bertoldo,Calogera Pisano,Dario Buioni,Laura Asta,Paolo Nardi

doi:10.3390/ijerph19010275

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.

Highlights

Introduction iationsOn-pump coronary artery bypass grafting (CABG) is considered the gold-standard treatment for severe CAD [1,2]
Complete revascularization was achieved in 97.2% of the patients in the clampless off-pump coronary artery bypass grafting (C-OPCAB) group and in 98.6% in the clamping coronary artery bypass grafting (C-CABG)
Surgical myocardial revascularization performed on cardiopulmonary bypass and cardioplegic myocardial protection is considered the gold standard for the treatment of patients affected by multivessel coronary artery disease since it provides a motionless, bloodless field for optimal construction of distal coronary anastomoses

Summary

Introduction

On-pump coronary artery bypass grafting (CABG) is considered the gold-standard treatment for severe CAD [1,2]. The off-pump procedure (OPCAB), which was assumed to be less harmful since it avoids CPB, failed to show significant early advantages over. CABG, while long-term results were often inferior to those achieved with the conventional technique [3,4]. In very fragile patients, or in cases with the severely diseased ascending aorta, OPCAB proved to be useful in preventing neurological or aortic complications, provided that any clamping was prevented (anaortic or clampless OPCAB, i.e., C-OPCAB) [5]. Facilitating devices have been developed to abstain from aortic side-clamping when proximal graft suturing was required.

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