Off-pump coronary artery bypass grafting with clampless aortic anastomosis devices: Aortic sealing devices versus automated anastomosis punching

Abstract

Objectives: Clampless aortic anastomosis devices aim to lower stroke risk in off-pump coronary artery bypass grafting. Two main strategies for clampless anastomosis devices emerged with automated anastomosis punching and aortic sealing devices, prompting the question of perioperative outcome differences.

Methods: All consecutive patients undergoing elective off-pump coronary artery bypass grafting with a clampless aortic anastomosis device between September 2014 and December 2021 in 2 centers were retrospectively included. Cohorts were divided by the use of an automated anastomosis punching device or an aortic sealing device to achieve proximal anastomosis on the ascending aorta. To reach group comparability propensity score matching was performed. The primary end point was defined as a composite of all-cause mortality, stroke and rethoracotomy. Secondary end points were perioperative outcome parameters.

Results: A total of 3703 patients were enrolled of whom 575 and 3128 were included in the automated anastomosis punching and the aortic sealing device group, respectively. By propensity score matching a total of 1150 patients were included with 575 in each group. The primary composite endpoint showed no significant difference with 6.3% versus 5.9% events (odds ratio, 0.9; 95% confidence interval, 0.58-1.53, P = .81). All-cause mortality (P = .36), stroke (P = .81), and rethoracotomy (P = .89) also exhibit no disparity. Operation time was significantly longer in the aortic sealing device cohort with 220.0 ± 50.8 minutes and 204.6 ± 53.8 minutes (P < .01).

Conclusions: Clampless aortic anastomosis strategies aortic sealing device and automated anastomosis punching did not differ in perioperative outcome parameters, whereas the implementation of aortic sealing devices were associated with a prolonged operation time without inducing any inferior clinical outcome.

Keywords: OPCAB; clampless aortic anastomosis device; clampless cardiac surgery; stroke.

Graphical abstract

Clampless bypass surgery with aortic sealing devices versus automated anastomosis punching.

Figure 1

Clampless aortic anastomosis devices. A, Aortic sealing devices; (B) automated anastomosis punching devices. AoSD, Aortic sealing device; AAP, automated anastomosis punching.

Figure 2

Patient-selection process. OPCAB, Off-pump coronary artery bypass grafting; AoSD, aortic sealing devices; AAP, automated anastomosis punching; PS, propensity score.

Figure 3

Off-pump coronary artery bypass grafting with clampless aortic anastomosis devices aortic sealing devices versus automated anastomosis punching. AoSD, Aortic sealing device; AAP, automated anastomosis punching; OR, Odds ratio; 95% CI, 95% confidence intervals; CAA, clampless aortic device; R&D, research and development.