title: Impact of proximal anastomosis procedures on stroke in off-pump coronary artery bypass grafting.
abstract: BACKGROUND
  There are many options for proximal anastomosis during off-pump coronary artery bypass grafting (CABG), but the efficacies of these procedures have not been well clarified. Therefore, we examined the clinical impact of our strategy to modify the proximal anastomosis procedure for aortic atherosclerosis.
  
  
  METHODS
  We retrospectively reviewed 535 consecutive patients undergoing off-pump CABG between 2004 and 2007. The patients were divided into three groups depending upon the type of proximal anastomosis procedure: 241 patients with normal or mild atherosclerosis underwent partial clamping (clamp group), 81 patients with moderate atherosclerosis underwent the procedure with Heartstring (Guidant Corporation, Santa Clara, CA, USA), 28 patients underwent with Enclose II (Novare Surgical Systems, Inc., Cupertino, CA, USA) (device group), and 185 patients underwent the procedure without clamping, including six with severe atherosclerosis (no-touch group).
  
  
  RESULTS
  There were seven in-hospital mortalities (1.3%) and five strokes (0.9%). There was no difference in the mortality rate (clamp, 1.2%; device, 1.8%; no-touch, 1.1%; p = 0.42) or stroke rate (clamp, 0.8%; device, 2.8%; no-touch, 0.5%; p = 0.09) among the three groups. Graft patency was similar regardless of the method (clamp, 94.7%; Heartstring, 96.7%; Enclosed II, 96.0%; p = 0.80).
  
  
  CONCLUSIONS
  Our strategy to modify the proximal anastomosis procedure resulted in a low stroke rate. Aortic clamping could be performed safely in patients with normal or mild atherosclerotic aorta. In patients with moderate atherosclerosis, the result of an anastomotic device may need a further investigation.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Asahicho, Fuchu, Tokyo, Japan. s-manabe@fb3.so-net.ne.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Manabe
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Keisuke
authors.initials: K
authors.lastname: Miyajima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Matsuyama
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D050197:Atherosclerosis / Q000401:mortality / Q000601:surgery*; D002544:Cerebral Infarction / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D013525:Surgical Instruments; D016019:Survival Analysis