Device use for proximal anastomosis on ascending aorta in off-pump coronary artery bypass grafting.

BACKGROUND: We recently reported early postoperative results comparing use of anastomosis-assist device (Device) with side-biting clamp for ascending aorta during coronary artery bypass grafting (CABG) except for transient neurological complications that occurred less often with Device. Here, we evaluated perioperative safety of Device against aorta no-touch technique (No-touch).

METHODS: We evaluated patients receiving isolated off-pump CABG with either Device or No-touch approach in 2014-2016 from Japan Adult Cardiovascular Surgery Database. We performed one-to-one matched analysis based on propensity score modeled from patient demographics, comorbidities, cardiac conditions and procedural characteristics. We compared early outcomes in both groups using Pearson's chi-square test/Wilcoxon rank sum test as appropriate with p<0.05 being statistically significant.

RESULTS: Among 9,546 Device and 6,890 No-touch patients, we found 5,012 patient matches for each group. Device operation time significantly longer (293 versus 281 minutes; p<0.001) and homologous transfusion significantly greater (56.9% versus 51.0%; p<0.001) than No-touch. Thirty-day operative mortality (1.5% versus 1.7%; p=0.34), morbidity and mortality (6.8% versus 7.5%; p=0.17) and stroke (0.9% versus 1.1%; p=0.36) similar in both groups. New onset atrial fibrillation (11.9% versus 10.3%; p=0.01) occurred significantly more often with Device. Newly initiated dialysis (1.4% versus 1.9%; p=0.051) more frequent with No-touch while re-operation for graft occlusion more frequent with Device (1.0% versus 0.6%; p=0.06), but not significant for either outcome.

CONCLUSIONS: Clinical safety of Device use in CABG comparable to No-touch for mortality and morbidity. Hemostasis may be a key issue for accomplishing higher level quality control when devices used in proximal anastomosis of CABG.