During OPCAB, the aortic no-touch technique is an effective method to reduce stroke. But use of that technique may limit the revascularization strategy for calcification of ascending aorta. There are many strategies for proximal anastomosis of SVG.
To examine the clinical impact of our strategy of proximal anastomotic device of SVG for calcification of ascending aorta.
We retrospectively reviewed 994 patients undergoing OPCAB between 2007 and 2014, The proximal anastomosis procedure of each group was Aorta no- touch technique, partial clamping, proximal anastomosis with device such as PAS-Port (Cardica, Inc, Redwood City, Calif), Heartstring(Guidant Corporation, Santa Clara, CA, USA), EncloseⅡ(Novare Surgical System, Inc., Cupertino, CA, USA). (Table.1)Calcification of the ascending aorta was assessed by non-contrast CT near the level of the right pulmonary artery where proximal anastomoses are usually made.
We retrospectively divided the patients into four groups based on maximum severity of calcification.(Figure.1)
The overall perioperative stroke was 1/994, whose patient was mild calcification of aorta, using aorta no-touch technique. Aortic dissection was two patients, one was mild calcification using partial clamp and other one was not calcification using partial clamp. Each group was similar using method.(Table.2)These two groups were no perioperative stroke. Impact of calcified aorta on SVG patency was similar in each group.(Table.3)
OPCAB with proximal anastomotic device provided both complete revascularization and stroke prevention, even in patients with calcified aorta. This device allows an automated and rapid anastomosis with minimal aortic manipulation and can be used in patients undergoing off-pump coronary artery bypass surgery. Ultimately, late angiographic follow-up would be required to confirm comparable long-term vein graft patency rates.