Safety and Efficacy of Multi-vessel Off-pump Coronary Artery Bypass Grafting Using Proximal Suture Device
Suguru Ohira, Kiyoshi Doi, Satoshi Numata, Sachiko Yamazaki, Keiichi Itatani, Hidetake Kawajiri, Kazuki Morimoto, Kaichiro Manabe, Kohki Ikemoto, Hitoshi Yaku.
Kyoto Prefectural University of Medecine, Kyoto, Japan.
OBJECTIVE: A proximal suture device (PSD) facilitates multi-vessel off-pump coronary artery grafting (OPCAB) without clamping the ascending aorta. The aim of this study was to investigate the results of OPCAB with the PSD regarding postoperative stroke and graft patency.
METHODS: From 1997 to 2012, 1,176 patients underwent isolated coronary artery bypass grafting (CABG). Since 2002, we have been using the PSD in OPCAB. The PSD was employed for 376 patients (32.0%), aorta-no-touch OPCAB was performed in 532 patients (45.2%), on-pump beating CABG (on-beat group) in 125 patients (10.6%) including 51 conversions (conversion rate: 5.4%), and CABG with an aortic clamp in 152 patients (clamp group). In the PSD group, EncloseIIwas used in 267 patients (71.0%).
RESULTS: he overall incidences of hospital mortality and stroke were 1.53 and 1.79%, respectively. In patients with conversion from OPCAB, the rate of postoperative stroke was 0%. There was no early stroke (recovered from anesthesia with neurological deficit) in OPCAB, whereas it occurred in 0.8% in the on-beat group and 2.6% in the clamp group. The incidences of stroke at 1 month were: PSD group, 1.6%; no-touch group, 1.3%; on-beat group, 1.6%; and clamp group, 4.6% (P=.018). The rates of complete revascularization were higher in the PSD and clamp groups (94.7, 81.5, 84.9, and 94.0%, respectively, P<.001). The patency rates of vein grafts and distal anastomosis were comparable between the PSD and clamp groups (proximal: 94.9 vs. 93.9%, P=.774; and distal: 93.9 vs. 95.7%, P=.656). Multiple logistic regression analysis demonstrated that OPCAB reduced the risk of stroke compared to on-pump CABG (adjusted odds ratio [AOR]: 0.34, 95% confidence interval [CI]: 0.13-0.89, P=.029). OPCAB using the PSD did not increase the risk of stroke compared with the no-touch group (AOR: 1.40, 95% CI: 0.40-4.89, P=.594) or the on-beat group (AOR: 0.99, 95% CI: 0.14-2.45, P=.206), but reduced the risk of stroke compared with the clamp group (AOR: 0.19, 95% CI: 0.06-0.61, P=.005).
CONCLUSIONS: OPCAB using the PSD demonstrated lower incidences of postoperative stroke and similar rates of graft patency and complete revascularization compared with conventional CABG.
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