Aortic calcification Partial Clamp And Choice Of Device On Off Pump Coronary Artery Bypass Graft
Akitoshi Takazawa, MD, Hiroyuki Nakajima, MD, Atsushi Iguchi, MD, Toshihisa Asakura, MD, Kazuhiko Uwabe, MD, Hiroyuki Koike, MD, Hiroshi Niinami, MD.
Saitama medical university International medical center, Hidaka city, Japan.
OBJECTIVE: During off-pump coronary artery bypass grafting (OPCAB), the aortic no-touch technique is an effective method to reduce stroke. But use of that technique may limit the revascularization strategy for calcification of ascending aorta. There are many strategies for proximal anastomosis of saphenous vein graft (SVG). Therefore, we examined the clinical impact of our strategy of proximal anastomotic device of SVG for calcification of ascending aorta.
METHODS: We retrospectively reviewed 979 patients undergoing CABG between 2007 and 2014, 40(4.1%) patients was moderate calcification (M group), 40(4.1%) was severe calcification (S group) and 146(14.9%) was mild calcification. The proximal anastomosis procedure of each group was Aorta no- touch technique, partial clamping, proximal anastomosis with device such as PAS-Port (Cardica, Inc, Redwood City, Calif), Heartstring(Guidant Corporation, Santa Clara, CA, USA), EncloseII(Novare Surgical System, Inc., Cupertino, CA, USA).
RESULTS: The overall perioperative stroke was 1/979, whose patient was mild calcification of aorta, using aorta no-touch technique. Aortic dissection was two patients, one was mild calcification using partial clamp and other one was not calcification using partial clamp. Each group was similar using method, M group was aorta no touch, 47.5%, Device, 42.5%, Partial clamp, 10.0%, S group was aorta no-touch, 57.5%, Device, 40.0%, Partial clamp, 2.5%. These two groups were no perioperative stroke. There was no difference in complete revascularization (M group: 100%, S group: 97.5%). Impact of calcified aorta on SVG patency was similar in each group.
CONCLUSIONS: OPCAB with proximal anastomotic device provided both complete revascularization and stroke prevention, even in patients with calcified aorta. This device allows an automated and rapid anastomosis with minimal aortic manipulation and can be used in patients undergoing off-pump coronary artery bypass surgery. Ultimately, late angiographic follow-up would be required to confirm comparable long-term vein graft patency rates.
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