Partially anaortic clampless off-pump coronary artery bypass prevents neurologic injury compared to on-pump coronary surgery: a propensity score-matched study on 286 patients.
Anaortic coronary artery bypass proved to prevent early neurologic injury compared to on-pump CABG. The Cardica PAS-Port(®) is a fully automated device that might be able to perform proximal aorto-venous anastomoses without an increased embolic risk. We evaluated early post-operative neurologic outcome in a matched population following clampless OPCAB (CCAB: either "all-arterial" or with automatically anastomosed venous grafts) or on-pump CABG. 366 consecutive patients were submitted to isolated coronary bypass by a single surgeon experienced in both off and on-pump procedures between January 2009 and December 2013. Of these patients, 223 underwent a clampless off-pump revascularization. After propensity score matching, 143 pairs were selected, who received either off-pump or on-pump surgery. In the off-pump group, CCAB was performed with an all-arterial approach (n = 33) or with automated proximal anastomosis of the venous graft(s) by means of the Cardica PAS-Port(®) connector (n = 110). Neurologic injury was defined as non-reversible (NRNI: lethal coma or stroke) or reversible (RNI: TIA or delirium). Operative mortality was 2.4 % (CCAB 1.4 %; CABG 3.5 %; p = 0.14). The global rate of early neurologic injury was 5.6 % (CCAB 2.1 vs. CABG 9.1 %; p = 0.006). Incidence was 1.4 % for NRNI (CCAB 0 vs. CABG 2.8 %; p = 0.04) and 4.2 % for RNI (CCAB 2.1 vs. CABG 6.3 %; p = 0.06). No differences were found among other major perioperative outcomes. CCAB prevents both early post-operative RNI and NRNI. This result can be achieved with a totally anaortic strategy and also with the aid of a fully automated device for proximal aorto-venous anastomoses.
Operative Units of Cardiac Surgery, Tor Vergata University, Rome, Italy. carlo.bassano@uniroma2.it.
Carlo
C
Bassano
Operative Units of Cardiac Surgery, Tor Vergata University, Rome, Italy.
Emanuele
E
Bovio
Operative Units of Cardiac Surgery, Tor Vergata University, Rome, Italy.
Floriano
F
Uva
Interdepartmental Center of Biostatistics and Bioinformatics, Tor Vergata University, Rome, Italy.
Simona
S
Iacobelli
Operative Units of Anesthesiology, Tor Vergata University, Rome, Italy.
Nicola
N
Iasevoli
Operative Units of Anesthesiology, Tor Vergata University, Rome, Italy.
Andrea
A
Farinaccio
Operative Units of Cardiac Surgery, Tor Vergata University, Rome, Italy.
Giovanni
G
Ruvolo
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003128:Coma / Q000209:etiology / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D003693:Delirium / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
CABG; Clampless; Neurologic injury; Off-pump surgery; Stroke