Abstract 18852: Benefit of Using Proximal Anastomosis Assist Device in Coronary Artery Bypass Grafting for 3-vessel Disease

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Introduction: Anastomosis assist device ('Device') use during coronary artery bypass grafting is thought to be less invasive to the ascending aorta than conventional side-biting clamp ('SBC') use and may result in less incidence of postoprative complications, however, this benefit has not been clearly presented.

Hypothesis: Use of 'Device' is beneficial in minimizing the postoperative complications in patients with 3-vessel disease undergoing off-pump coronary artery bypass grafting (OPCAB) in comparison to use of 'SBC'.

Methods: Patients with 3VD who received isolated OPCAB were retrospectively reviewed using the Japan Adult Cardiovascular Surgery Database (2008-2012). We performed a one-to-one matched analysis on the basis of estimated propensity scores for patients either with ‘Device’ or ‘SBC’ and obtained two cohorts with 6,014 patients in each group balanced for baseline characteristics out of 9604 ‘Device’ and 6045 ‘SBC’ patients. We compared detailed procedures, early outcomes including 30-day operative mortality and details of postoperative complications between the groups using Pearson’s chi-square test with p < 0.05 being statistically significant.

Results: Short-term results showed significantly lower stroke rate (1.0% vs 1.5%, p=0.016), lower incidence of renal failure (3.5% vs 4.3%, p=0.018), and lower incidence of Atrial fibrillation (13.4% vs 14.7%, p=0.049). Blood products were more frequently used in ‘Device’. Procedure time was slightly longer in ‘Device’ (325min vs 320min, p=0.001). Operative mortality (1.3% vs 1.6%, p=0.321), and mortality & morbidity (9.7% vs 9.6%, p=0.781) were not different between the 2 groups.

Conclusions: Use of ‘Device’ contributed decreasing the incidence of particular perioperative complications including cerebrovascular events and renal failure, whereas it did not affect either short-term survival or overall morbidity rate in 3-vessel disease patients undergoing OPCAB.

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