Total arterial off-pump surgery provides excellent outcomes and does not compromise complete revascularization

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Minimally Invasive Cardiac Procedures

Background:

• Aortic no-touch off-pump surgery (OPCAB) combined with total arterial revascularization (TAR) offers potential benefits in reducing peri-procedural morbidity and improving long-term outcomes.
• A key concern with OPCAB-TAR is the potential for incomplete revascularization, particularly in patients with complex coronary artery disease.
• Evaluating the feasibility of OPCAB-TAR for achieving complete revascularization (CR) in multi-vessel disease is crucial for optimizing patient care.

Purpose of the Study:

• To assess the feasibility and outcomes of aortic no-touch off-pump surgery combined with total arterial revascularization (OPCAB-TAR).
• To specifically evaluate the rate of complete revascularization (CR) achieved with OPCAB-TAR in patients with multi-vessel disease.
• To compare the safety and efficacy of OPCAB-TAR versus on-pump total arterial revascularization (ONCABG-TAR).

Main Methods:

• A retrospective analysis of 712 patients undergoing TAR between 2003 and 2010, comparing 526 OPCAB-TAR cases with 186 ONCABG-TAR cases.
• Propensity score matching was employed to balance patient characteristics between the OPCAB-TAR and ONCABG-TAR groups.
• Complete revascularization (CR) was assessed using an 'Index of CR' (ICOR) and defined by specific criteria, alongside evaluation of mortality, stroke, and MACCE.

Main Results:

• OPCAB-TAR patients demonstrated significantly lower rates of MACCE (3.0% vs. 7.0%) and a trend towards reduced stroke and myocardial infarction compared to ONCABG-TAR.
• In the triple-vessel disease (TVD) subgroup, OPCAB-TAR showed significantly lower MACCE (1.8% vs. 5.8%) and stroke rates.
• Despite a slightly lower ICOR, OPCAB-TAR achieved higher CR rates (82.1% vs. 73.1%) overall and comparable CR in the TVD subgroup.

Conclusions:

• Aortic no-touch OPCAB-TAR significantly reduces MACCE and can be safely applied to patients with multi-vessel disease.
• This surgical approach does not compromise complete revascularization in patients with triple-vessel disease.
• OPCAB-TAR represents a safe and effective strategy for achieving excellent long-term outcomes in selected patient populations.