title: Clampless off-pump versus conventional coronary artery revascularization: a propensity score analysis of 788 patients.
abstract: BACKGROUND
  This study aimed to assess if clampless off-pump coronary artery bypass grafting (CABG) decreases risk-adjusted mortality, stroke rate, and morbidity in unselected patients in comparison to conventional CABG.
  
  
  RESULTS
  Between July 2009 and November 2010, data of 1282 consecutive patients undergoing isolated CABG were prospectively recorded. In 30.8% (n=395), clampless off-pump revascularization was used, either with the PAS-Port automated central venous anastomosis system (n=310) or as total arterial revascularization without central anastomoses (n=85). Propensity score (PS) matching was performed based on 15 preoperative risk variables to correct for selection bias. In-hospital mortality and stroke rate as primary end point, as well as major complications and follow-up outcome of clampless off-pump (lessOPCAB) and conventional CABG (cCABG) were compared in 394 matched patient pairs (total: 788 patients). The clampless off-pump technique decreased the in-hospital rate of death (odds ratio, 0.25; 95% confidence interval, 0.05-1.18, P=0.080) and stroke (odds ratio, 0.36; 95% confidence interval, 0.13-0.99, P=0.048) significantly. Complications such as low cardiac output syndrome, prolonged ventilation and rethoracotomy were also reduced by lessOPCAB. Over a 2-year follow-up period overall survival, cerebrovascular and major adverse event rate were significantly lower in the lessOPCAB group, while the repeat revascularization rate was comparable.
  
  
  CONCLUSIONS
  In a retrospective PS-matched analysis, clampless off-pump CABG lowers mortality, stroke rate and other morbidity in an unselected group of patients with coronary artery disease.
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany. jboergermann@hdz-nrw.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
authors.forename: Kavous
authors.initials: K
authors.lastname: Hakim
authors.forename: André
authors.initials: A
authors.lastname: Renner
authors.forename: Amin
authors.initials: A
authors.lastname: Parsa
authors.forename: Anas
authors.initials: A
authors.lastname: Aboud
authors.forename: Tobias
authors.initials: T
authors.lastname: Becker
authors.forename: Marc
authors.initials: M
authors.lastname: Masshoff
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Jan Fritz
authors.initials: JF
authors.lastname: Gummert
authors.forename: Oliver
authors.initials: O
authors.lastname: Kuss
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003250:Constriction; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000706:statistics & numerical data; D004617:Embolism / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D015983:Selection Bias; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome