Tailoring graft strategy to calcification severity of aorta in off-pump coronary artery bypass grafting

Abstract

Background: The study aimed to assess the influence of the calcification of the ascending aorta on surgical mortality, postoperative stroke, and completeness of coronary revascularization in patients undergoing off-pump coronary artery bypass grafting with graft strategy tailored to its calcification severity. Methods and results: We examined the clinical records of 726 patients who underwent off-pump coronary artery bypass grafting. The age at operation was 71 ± 8 years. Calcification of the ascending aorta was graded as none–mild (less than spotty) in 668 (92.0%), moderate (<1/4 of circumference) in 26 (3.6%), and severe (>1/4) in 32 (4.4%) by preoperative non-contrast computed tomography. There were no significant differences in the number of distal anastomoses per patient among the three groups (3.3 ± 1.1, 2.9 ± 1.0, and 3.0 ± 0.9, respectively; p = 0.85). Graft strategy was tailored for each patient. Proximal anastomosis with partial clamp was used in 43.8%, 7.7%, and 3.1%, respectively (p < 0.001), while anastomotic devices were used in 6.8%, 30.1%, and 28.1%, respectively (p < 0.001). Other patients had aortic no-touch technique. There were four hospital deaths in the none–mild group (0.6%, p = 0.85). Stroke occurred in 1 (0.1%) patient, an aortic no-touch technique patient with none–mild calcification. Complete revascularization was not possible in 1 (0.1%) patient in the severe calcification group. Patency of saphenous vein graft of distal anastomosis was not different among groups. Conclusion: Influence of the calcification of the ascending aorta was minimized by tailoring graft strategy to calcification severity. It can practically abolish postoperative stroke while maintaining coronary revascularization success rates.