TY - JOUR
T1 - Device Use for Proximal Anastomosis on Ascending Aorta in Off-Pump Coronary Artery Bypass Grafting
AU - Saito, Aya
AU - Kumamaru, Hiraku
AU - Miyata, Hiroaki
AU - Motomura, Noboru
N1 - Funding Information:
The authors wish to thank Christopher Dix for his assistance in the editing of this manuscript. Hiraku Kumamaru and Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment, which is a social collaboration department at the University of Tokyo supported by the National Clinical Database, Johnson & Johnson K.K. and Nipro Corporation.
Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/6
Y1 - 2021/6
N2 - Background: We recently reported early postoperative results comparing the use of an anastomosis-assist device with a side-biting clamp for ascending aorta during coronary artery bypass grafting (CABG). Transient neurological complications occurred less often with the device. Here, we evaluated the perioperative safety of the device compared with the aorta no-touch technique (no-touch). Methods: We evaluated patients listed in the Japan Adult Cardiovascular Surgery Database who received isolated off-pump CABG with either the device or the no-touch approach from 2014 to 2016. We performed a one-to-one matched analysis based on a propensity score modeled from patient demographics, comorbidities, cardiac conditions, and procedural characteristics. We compared early outcomes in both groups using Pearson's chi-square or Wilcoxon rank sum test as appropriate; P less than.05 was statistically significant. Results: Among 9546 device and 6890 no-touch patients, we found 5012 patient matches for each group. The device operation time was significantly longer (293 versus 281 minutes; P <.001) and homologous transfusion was significantly greater (56.9% versus 51.0%; P <.001) than with no-touch. Thirty-day operative mortality (1.5% versus 1.7%; P =.34), morbidity and mortality (6.8% versus 7.5%; P =.17), and stroke (0.9% versus 1.1%; P =.36) were similar in both groups. New-onset atrial fibrillation (11.9% versus 10.3%; P =.01) occurred significantly more often with the device. Newly initiated dialysis (1.4% versus 1.9%; P =.051) was more frequent with no-touch whereas reoperation for graft occlusion was more frequent with the device (1.0% versus 0.6%; P =.06) but was not significant for either outcome. Conclusions: The clinical safety of use of the device in CABG was comparable to no-touch for mortality and morbidity. Hemostasis may be a key issue for accomplishing higher-level quality control when devices are used in proximal anastomosis of CABG.
AB - Background: We recently reported early postoperative results comparing the use of an anastomosis-assist device with a side-biting clamp for ascending aorta during coronary artery bypass grafting (CABG). Transient neurological complications occurred less often with the device. Here, we evaluated the perioperative safety of the device compared with the aorta no-touch technique (no-touch). Methods: We evaluated patients listed in the Japan Adult Cardiovascular Surgery Database who received isolated off-pump CABG with either the device or the no-touch approach from 2014 to 2016. We performed a one-to-one matched analysis based on a propensity score modeled from patient demographics, comorbidities, cardiac conditions, and procedural characteristics. We compared early outcomes in both groups using Pearson's chi-square or Wilcoxon rank sum test as appropriate; P less than.05 was statistically significant. Results: Among 9546 device and 6890 no-touch patients, we found 5012 patient matches for each group. The device operation time was significantly longer (293 versus 281 minutes; P <.001) and homologous transfusion was significantly greater (56.9% versus 51.0%; P <.001) than with no-touch. Thirty-day operative mortality (1.5% versus 1.7%; P =.34), morbidity and mortality (6.8% versus 7.5%; P =.17), and stroke (0.9% versus 1.1%; P =.36) were similar in both groups. New-onset atrial fibrillation (11.9% versus 10.3%; P =.01) occurred significantly more often with the device. Newly initiated dialysis (1.4% versus 1.9%; P =.051) was more frequent with no-touch whereas reoperation for graft occlusion was more frequent with the device (1.0% versus 0.6%; P =.06) but was not significant for either outcome. Conclusions: The clinical safety of use of the device in CABG was comparable to no-touch for mortality and morbidity. Hemostasis may be a key issue for accomplishing higher-level quality control when devices are used in proximal anastomosis of CABG.
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U2 - 10.1016/j.athoracsur.2020.08.016
DO - 10.1016/j.athoracsur.2020.08.016
M3 - Article
C2 - 33065052
AN - SCOPUS:85103976220
SN - 0003-4975
VL - 111
SP - 1909
EP - 1915
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -