Reduktion von perioperativer Letalität und Morbidität in der Koronarchirurgie mit Clampless-off-pump-Technik. Propensity-Score-Analyse von 788 Patienten

Background: This study aimed to assess whether the use of the clampless off-pump coronary artery bypass grafting (CABG) technique decreases risk-adjusted mortality, stroke rate, and morbidity in an unselected patient population. Patients and methods: Between July 2009 and November 2010, data of 1,282 consecutive patients undergoing isolated CABG were prospectively recorded in a clinical database. In 30.8% (n=395), the procedures were completed clampless off-pump, either using the PAS-Port automated central venous anastomosis system or as total arterial revascularization without central anastomoses. Propensity score (PS) matching was performed based on 15 variables representing preoperative risk factors to correct for selection bias. Procedural mortality, stroke rate, major complications, and resources utilization of clampless off-pump (less OPCAB) and conventional CABG (cCABG) were compared. Results: A total of 788 patients (394 pairs) undergoing CABG were able to be successfully matched. The clampless off-pump technique significantly decreased the rates of death (OR: 0.25, 95%-CI: 0.05-1.17) and stroke (OR: 0.35, 95%-CI: 0.12-0.98). Complications, including low output syndrome, prolonged ventilation, and reoperation, were also reduced by less OPCAB. Conclusion: In a retrospective PS-matched analysis, less OPCAB lowers mortality, stroke rate, and other morbidity in an unselected group of patients with coronary artery disease.