# Clinical Outcomes of the Sushi Technique in Off-Pump Coronary Artery Bypass Grafting for Patients With Aortic Disease: A Propensity Score-Matched Analysis

## TL;DR

This study compares a new surgical technique called the Sushi method with traditional methods in heart bypass surgery for patients with aortic disease.

## Contribution

The study introduces and evaluates the Sushi technique as a viable alternative for patients with aortic disease undergoing off-pump coronary artery bypass grafting.

## Key findings

- The Sushi technique did not increase stroke rates compared to traditional methods.
- There was no significant difference in survival or major adverse cardiac events between the two techniques.

## Abstract

Objectives: Typically, the saphenous vein graft (SVG) is directly anastomosed to the aorta using a side-clamp in off-pump coronary artery bypass grafting (OPCAB). However, in patients with aortic disease, an anastomosis assist device is used, and in some cases, an additional vein graft is anastomosed onto the primary SVG, a technique we refer to as the Sushi technique.

Methods: We retrospectively analyzed 433 OPCAB patients who underwent left internal mammary artery to left anterior descending bypass with aorta-SVG (Ao-SVG) bypass from April 2011 to July 2024. Patients were divided into the Sushi group (n=56) and Ao-SVG group (n=377). A 1:1 propensity score matching was performed (Sushi n=56; Ao-SVG n=56). The Sushi technique was used in patients with aortic disease detected by preoperative CT or intraoperative echocardiography, whereas multiple Ao-SVG anastomoses were performed in those with a healthy aorta.

Results: There were 39 (69.6%) and 195 (51.7%) males, and the mean age was 66.9±8.7 and 66.4±8.4 years in the unmatched cohort, and 39 (69.6%) and 38 (67.9%) males and 66.9±8.7 and 67.3±8.5 years in the matched cohort in the Sushi and Ao-SVG groups, respectively. Stroke rates were comparable (3.6% vs. 1.6%, p=0.28; matched: 3.6% vs. 1.8%, p=1.00). There were no significant differences in major adverse cardiac or cerebrovascular event (MACCE)-free survival (p=0.228) or overall survival (p=0.783).

Conclusion: The new stroke rates did not differ between the groups, suggesting that the Sushi technique could be a viable strategy for patients with aortic disease. Additionally, there was no significant difference between the two groups at five-year free of MACCE or survival rates.