Abstract 968 Perioperative Outcome of Off-Pump Coronary Artery Bypass Grafting with Clampless Aortic Anastomosis Devices: Automated Anastomosis Punching vs. Aortic Sealing Devices.

Off-pump coronary artery bypass grafting (OPCAB) is a well-established surgical strategy to achieve myocardial revascularization while reducing stroke risk by avoiding extracorporeal circulation and in particular aortic clamping by using clampless aortic anastomosis (CAA) devices. Two main strategies to avoid aortic clamping were followed with automated anastomosis punching (AAP) and aortic sealing devices (AoSD) arising the question of perioperative outcome differences. Since automated anastomosis punching devices are currently no longer available, forcing the field of OPCAB surgery to a one-strategy only path, a deep understanding of the systems is of crucial interest to draw the further path of clampless bypass surgery.

All consecutive patients undergoing elective isolated OPCAB with a CAA between 09/2011--12/2021 in two centers were retrospectively included in this study. Cohorts were divided by the use of an AAP device or an AoSD to achieve proximal venous anastomosis on the ascending aorta. To reach group comparability propensity score (PS) matching was performed by 30 baseline characteristics. Primary endpoints were perioperative outcome parameters. Secondary endpoints were intraoperative parameters and transfusion rate.

A total of 4,719 patients were enrolled, of whom 4,249 and 470 were included in the AAP and the AoSD group, respectively. Through PS matching, a cohort auf 940 patients with 470 in each group was included in the final analysis. While the AoSD group showed a longer operation time (203.1±48.6. vs. 219.0±53.0 [min], 95%CI[-22.47; -9.44], p<0.001), perioperative outcomes did not differ between the groups (table 1).

The need for platelets transfusion (12.5% vs. 4.5%, p=0.001) and plasma (1.6±6.5 vs. 0.4±1.1 [units], p<0.001) was significantly higher in the AAP group. Regarding the red blood cells transfusion, a tendency was observed to a higher need in the AAP (table 1).

Variable

AAP

(n=470)

AoSD

(n=470)

OR [95%CI]

p-value

[n (%) or mean±STD]

Perioperative Outcome

Operation time [min]

203.1±48.6

219.0±53.0

-22.47; -9.44

<0.001

ICU stay [days]

2.3±5.6

2.13±5.1

-0.50; 0.87

0.59

Need for dialysis

14 (3.0)

1.00 [0.47; 2.12]

>0.99

Need for coronary angiography/ intervetion

11 (2.3)

14 (3.0)

1.28 [0.58; 2.85]

0.54

CPR

8 (1.7)

9 (1.9)

1.13 [0.43; 2.95]

0.81

Re-thoracotomy

17 (3.6)

22 (4.7)

1.31 [0.69; 2.50]

0.41

In-hospital mortality

1 (0.2)

5 (1.1)

5.04 [0.59; 43.33]

0.10

Stroke

5 (1.1)

1.00 [0.29; 3.48]

>0.99

ECLS

4 (0.9)

1.00 [0.25; 4.02]

>0.99

Transfusion

Packed red blood cells [Units]

3.4±9.8

2.3±3.6

-0.07; 2.2

0.07

Plasma [Units]

1.6±6.5

0.4±1.1

0.53; 1.95

0.001

Platelets

37 (12.5)

15 (4.5)

0.33 [0.17; 0.61]

<0.001

CAA devices in OPCAB surgery with an aortic sealing or an automated anastomosis punching system do not differ in perioperative outcome parameters. However, prolonged overall operation time was observed in the AoSD group, whereas the AAP group presented a higher rate of plasma and platelets transfusions.