Gerçek Mustafa, Skuljevic Tomislav, Deutsch Marcus-André, Gummert Jan, Börgermann Jochen
Heart Center Duisburg, Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Duisburg, Germany.
Ruhr-University Bochum, Bochum, Germany.
JTCVS Tech. 2024 Jan 23;24:92-104. doi: 10.1016/j.xjtc.2024.01.010. eCollection 2024 Apr.
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.
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.
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, = .81). All-cause mortality ( = .36), stroke ( = .81), and rethoracotomy ( = .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 ( < .01).
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.
无钳主动脉吻合装置旨在降低非体外循环冠状动脉旁路移植术中的中风风险。随着自动吻合打孔和主动脉封闭装置的出现，无钳吻合装置出现了两种主要策略，这引发了围手术期结果差异的问题。
回顾性纳入2014年9月至2021年12月期间在2个中心接受使用无钳主动脉吻合装置的择期非体外循环冠状动脉旁路移植术的所有连续患者。根据使用自动吻合打孔装置或主动脉封闭装置在升主动脉上进行近端吻合将队列分组。为实现组间可比性，进行了倾向评分匹配。主要终点定义为全因死亡率、中风和再次开胸手术的综合指标。次要终点为围手术期结果参数。
共纳入3703例患者，其中自动吻合打孔装置组575例，主动脉封闭装置组3128例。通过倾向评分匹配，共纳入1150例患者，每组575例。主要复合终点无显著差异，事件发生率分别为6.3%和5.9%（比值比，0.9；95%置信区间，0.58 - 1.53，P = 0.81）。全因死亡率（P = 0.36）、中风（P = 0.81）和再次开胸手术（P = 0.89）也无差异。主动脉封闭装置队列的手术时间明显更长，分别为220.0±50.8分钟和204.6±53.8分钟（P < 0.01）。
无钳主动脉吻合策略（主动脉封闭装置和自动吻合打孔）在围手术期结果参数方面没有差异，而主动脉封闭装置的应用与手术时间延长相关，但未导致任何较差的临床结果。
