Study results
Patient characteristics are listed in Table 1 . The study cohort
included 251 patients. Among them, 217 (86%) were male and the median
age at operation was 68 years (IQR 61-74). Median pre-operative ejection
EF was 60% (IQR 52-64) and 40 patients (16%) of the entire cohort had
had prior percutaneous coronary intervention (PCI). Patients were
divided in two comparable groups (SAC vs. DAC) with no statistically
significant difference in demographic characteristics, family history,
comorbidities, Euroscore I value and functional class. SAC group
included 118 patients while DAC group included 133.
Surgical details are listed in Table 2 . A total of 13
operations (5%) were emergent surgeries. A total of 11 emergent
surgeries (84.61%) was in the DAC group (p value 0.019), accounting for
the 8% of this cohort.
The grafts used to perform CABG were left internal mammary artery (LIMA)
in situ, right internal mammary artery (RIMA) in situ, great saphenous
vein (GSV) and left or right arterial artery when GVS was unavailable,
always anastomosed to the ascending aorta proximally. Coronary arteries
were variably grafted according to the disease as described in Table 2,
with no significant difference between the two groups. All distal
anastomosis were performed during cardiac arrest (cross-clamping). No
difference between the two group was found regarding the number of
distal anastomosis, performed either with an arterial (p value 0.71) or
a venous graft (p value 0.071). When feasible, a sequential
configuration was chosen, performing no more than two bypasses with the
same graft.
Single proximal anastomoses were performed in 44 (37,2%) and 61
(45,8%) for the SAC and the DAC groups, respectively (p=0,2). Double
proximal anastomoses were 74 (62,8%) and 72 (54,2%) for the SAC and
the DAC groups, respectively.
In the SAC group all the proximal anastomoses were performed during the
period of total aortic cross clamping (cardiac arrest). In the DAC group
the proximal anastomoses were performed on a beating heart with the aid
of a side clamp.
Median surgical time of all cohort and for single group was 240 minutes,
with different interquartile ranges for the two groups, 225-300 minutes
for DAC and 210-270 minutes for SAC, which account for the statistical
significant difference (p= 0.015). Median cross-clamp time was
longer although not statistically different for the SAC group, 74
minutes (IQR 64-88) vs 72 minutes (IQR 56-84), CPB time was
significantly longer in the DAC group, 101 minutes IQR (83-116) vs 88
minutes (IQR 78-103) with a p < .001. On the
other hand, it’s important to highlight that a statistically relevant
part of the DAC group (11 patients, 8% p=0.019 ) were referred as
emergent surgery and were in worse general conditions, needing longer
perfusion CPB time to be weaned off.
We did not found any statistically significant differences in blood loss
(median 600 cc IQR 450-750 vs 630 cc IQR 450-850) and blood product use
(55 patients -41%- vs 53 patients -45%-) within the two groups (DAC vs
SAC respectively). Surgical re-exploration for excessive post-operative
bleeding was required in 5 patients for each group (4% of the entire
cohort). Moreover, no difference in total hours of post-operative
invasive ventilation (median of 5 hours IQR 4-7 for each group) neither
in total hours of intensive care unit (ICU) stay (mean of 49±27 hours)
were found. Hospital stay was also comparable with a median of 7 days
(IQR 7-9) of total length.
No relevant differences were found in the analysis of peri-procedural
complications including the study primary outcome of stroke and
transient ischemic attack (Table 3 ). The two groups presented
in addition a similar 30-day survival.
Peri-procedural myocardial infarction was overall reported in 7 patients
(3%), with no difference between the groups. Acute renal failure
occurred in 16 patients (6%), and 3 (1.5%) needed dialysis assistance.
Heart block occurred in 3 patients (1.5%) while reversible atrial
fibrillation in 54 patients (22%) of the cohort. We had 5 cases of
ischemic stroke (2%) with no difference between the two groups (2 -2%-
vs 3 -3%- patients, P . 56) while the only case of transient
ischemic attack was in the DAC group. No significant differences could
be identified. Major Adverse Cerebral and cardiovascular events (MACCE)
was 5 (5%) for the DAC group and 7 (6%) for the SAC group (p=0,57).
Mortality rate at 30 days was 0.5% accounting for one death in the DAC
group.