Long-term follow-up of device-assisted clampless off-pump coronary artery bypass grafting compared with conventional on-pump technique

Study objective: To evaluate the long-term outcomes of clampless off-pump coronary artery bypass grafting (C-OPCAB) compared with conventional on-pump double clamping coronary artery bypass grafting (C-CABG). Methods: From October 2006 to December 2011, 366 patients underwent isolated coronary artery bypass grafting. After propensity score matching of preoperative variables, 143 pairs were selected who received C-OPCAB with the use of device-assisted PAS-Port proximal venous graft anastomoses or C-CABG, performed by the same surgeon experienced in both techniques. Data of the two groups of patients were retrospectively analyzed up to 14 years of follow-up. Results: As compared with C-OPCAB, in the C-CABG patients, the performed number of grafts per patient was higher (2.9 +/- 0.5 vs. 2.6 +/- 0.6, p-value 0.0001). At 14 years, overall survival, including in-hospital death, was 64 +/- 4.7% for the C-OPCAB vs. 55 +/- 5.5% for the C-CABG, freedom from overall MACCEs 51 +/- 6.2% vs. 41 +/- 7.7%, and from late cardiac death 94 +/- 2.4% vs. 96 +/- 2.2% (p-value not significant, for all comparisons). No significant statistical differences were observed in the actual rates of adverse events during follow-up. Independent predictors of survival were advanced age at operation (p-value 0.001) and a lower mean value of preoperative left ventricular ejection fraction (p-value 0.015). Conclusions: Our single-center study analysis suggests that clampless OPCAB using device-assisted proximal anastomoses proved to be not inferior to double-clamping CABG in the long-term follow-up, provided that involved surgeons are familiar with both techniques. These conclusions are supported by a large and long-term follow-up period, eliminating potential bias, i.e., by means of the propensity score matching and analyzing single-surgeon experience.