Original article
Adult cardiac
Device Use for Proximal Anastomosis on Ascending Aorta in Off-Pump Coronary Artery Bypass Grafting

Presented at the Poster Session of the Fifty-sixth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 25-28, 2020.
https://doi.org/10.1016/j.athoracsur.2020.08.016Get rights and content

Background

We recently reported early postoperative results comparing the use of an anastomosis-assist device with a side-biting clamp for ascending aorta during coronary artery bypass grafting (CABG). Transient neurological complications occurred less often with the device. Here, we evaluated the perioperative safety of the device compared with the aorta no-touch technique (no-touch).

Methods

We evaluated patients listed in the Japan Adult Cardiovascular Surgery Database who received isolated off-pump CABG with either the device or the no-touch approach from 2014 to 2016. We performed a one-to-one matched analysis based on a propensity score modeled from patient demographics, comorbidities, cardiac conditions, and procedural characteristics. We compared early outcomes in both groups using Pearson’s chi-square or Wilcoxon rank sum test as appropriate; P less than .05 was statistically significant.

Results

Among 9546 device and 6890 no-touch patients, we found 5012 patient matches for each group. The device operation time was significantly longer (293 versus 281 minutes; P < .001) and homologous transfusion was significantly greater (56.9% versus 51.0%; P < .001) than with no-touch. Thirty-day operative mortality (1.5% versus 1.7%; P = .34), morbidity and mortality (6.8% versus 7.5%; P = .17), and stroke (0.9% versus 1.1%; P = .36) were similar in both groups. New-onset atrial fibrillation (11.9% versus 10.3%; P = .01) occurred significantly more often with the device. Newly initiated dialysis (1.4% versus 1.9%; P = .051) was more frequent with no-touch whereas reoperation for graft occlusion was more frequent with the device (1.0% versus 0.6%; P = .06) but was not significant for either outcome.

Conclusions

The clinical safety of use of the device in CABG was comparable to no-touch for mortality and morbidity. Hemostasis may be a key issue for accomplishing higher-level quality control when devices are used in proximal anastomosis of CABG.

Section snippets

Japanese Cardiovascular Surgery Database as a National Clinical Database

The JCVSD is a nationwide registry of patients undergoing cardiovascular surgery in Japan that was described previously.2 Data collection is conducted using the National Clinical Database platform; information is linked to cardiovascular surgery certification with participating cardiac surgical units surveyed every year to ensure the exact dominance of cases against actual overall surgical cases performed across the country. Data from 580 cardiac surgery units located throughout Japan (nearly

Results

We identified 41,567 patients undergoing isolated OPCAB during the study period in JCVSD. After excluding those who did not meet inclusion criteria (25,131), we enrolled 6890 and 9546 patients undergoing OPCAB using no-touch or a device, respectively, and then identified 5012 matching patients for each group.

Comment

Numerous reports and discussions have addressed the impact of various types of ascending aortic manipulation during CABG for perioperative complications, especially the incidence of stroke.2,8, 9, 10, 11, 12, 13, 14, 15 In beginning our review of results other than neurological events, we found that the longer operation time in the device group may have resulted from proximal anastomosis requiring additional manipulation compared with the no-touch group, whereas the more frequent use of

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© 2021 by The Society of Thoracic Surgeons Published by Elsevier