Anaortic Off-Pump vs Conventional CABG: A Propensity-Matched Single-Center Experience

Background Obesity is associated with increased perioperative risk in coronary artery bypass grafting (CABG), including higher rates of stroke, bleeding, and prolonged recovery. Anaortic, off-pump CABG, avoiding cardiopulmonary bypass and aortic manipulation, may mitigate these risks. We evaluated outcomes of anaortic off-pump CABG vs CABG with aortic manipulation in obese patients with 3-vessel disease. Methods We conducted a retrospective, single-center study of obese patients (body mass index >30 kg/m 2 ) with 3-vessel coronary artery disease who were undergoing isolated CABG. Patients were stratified by surgical technique: anaortic off-pump CABG vs CABG with aortic manipulation. Propensity score matching (1:2) was performed to adjust for baseline differences. The primary outcome was 30-day death or stroke. Secondary outcomes included transfusion, operative time, and major postoperative complications. Results After propensity matching, 926 patients were included (320 with anaortic CABG; 606 with CABG with aortic manipulation). The anaortic group had significantly lower rates of 30-day death or stroke (0.9% vs 3.6%; P = .028), shorter operative times (293 minutes vs 352 minutes; P < .001), and fewer intraoperative transfusions (8.2% vs 25.0%; P < .001). When assessed relative to The Society of Thoracic Surgeons predicted risk, the anaortic strategy was associated with lower observed-to-expected mortality (0.31 vs 0.99; P = .032) and stroke (0.00 vs 0.74; P = .018). Other postoperative complications were similar between groups. Conclusions In obese patients with multivessel coronary artery disease, anaortic off-pump CABG was associated with reduced rates of early death or stroke, fewer transfusions, and shorter operative times. These findings support the use of the anaortic technique and highlight its potential role in optimizing outcomes in the growing population of obese CABG candidates.