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Anaortic versus Clampless Off-Pump versus Conventional Coronary Artery Bypass Grafting - Midterm Analysis of 5,422 Unselected Patients
Nobuyuki Furukawa1, Konstantin Preindl1, Andre Renner1, Anas Aboud1, Kavous Hakim-Meibodi1, Michael Benzinger1, Thomas Pühler1, Stephan Ensminger1, Tobias Becker1, Oliver Kuss2, Jan-Fritz Gummert1, Jochen Börgermann1.
1Herz- und Diabeteszentrum NRW Ruhr University of Bochum, Bad Oeynhausen, Germany, 22Inst. for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
OBJECTIVE: Metaanalyses from observational studies and randomized studies have been able to demonstrate benefits of off-pump surgery for hard endpoints and surrogate endpoints. In some of these investigations, however, an increased re-revascularization rate was noted in the off-pump groups, which in turn could impact the long-term survival of these patients. Against this background we analyzed the course of all patients undergoing isolated coronary surgery according to the major cardiac and cerebrovascular event (MACCE) criteria.
METHODS: A prospective register was taken from a single high-volume off-pump center recording all anaortic off-pump (ANA; n=1,233), clampless off-pump (PasPort; n=2,310) and conventional (CONV; n=1,879) coronary artery bypass operations during the period from 07/2009 to 06/2015. Propensity Score Matching was performed based on 28 preoperative risk factors, including the EuroSCORE II and German CABG Score (KCH), to correct for selection bias between the three groups.
RESULTS: We were able to find 937 triplets (n=2,811) ANA vs. PasPort vs. CONV. Compared with the conventional group, the in-hospital mortality of the ANA group was significantly better (OR for ANA [95%-CI] 0.23 [0.05; 0.75], p=0.01), and that of the PasPort group better, with a clearly noticeable trend (OR for PasPort [95%-CI] 0.46 [0.16; 1.20], p=0.12).
In the mid-term course (median 849 days) there were no longer any significant differences for mortality (HR for ANA [95%-CI] 0.68 [0.48; 1.03], p=0.07; HR for PasPort [95%-CI] 0.83 [0.55; 1.25], p=0.38; reference: CONV), stroke (HR for ANA [95%-CI] 1.00 [0.54; 1.86], p=0.99; HR for PasPort [95%-CI] 1.06 [0.56; 2.01], p=0.86), myocardial infarction (HR for ANA [95%-CI] 0.50 [0.20; 1.28], p=0.15; HR for PasPort [95%-CI] 0.67 [0.29; 1.53], p=0.34) or re-revascularization (HR for ANA [95%-CI] 0.78 [0.53; 1.14], p=0.19; HR for PasPort [95%-CI] 0.86 [0.61; 1.29], p=0.53).
CONCLUSIONS: These data show in the mid-term course no difference with regard to the major cardiac and cerebrovascular events (MACCE) between anaortic off-pump, clampless off-pump using the PasPort device und conventional coronary artery bypass grafting. 
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