Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome
Open Access
- 1 March 2001
- journal article
- research article
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 19 (3) , 239-244
- https://doi.org/10.1016/s1010-7940(01)00572-3
Abstract
Objectives: To determine whether patients with critical left main stem (LMS) coronary artery disease can undergo off-pump coronary artery bypass (OPCAB) surgery safely and successfully. Methods: From May 1996 to March 2000 data for patients with critical (≧50%) LMS stenosis who underwent conventional coronary artery bypass surgery with cardiopulmonary bypass (CCAB) or without (OPCAB) were collected prospectively using the Patient Analysis & Tracking System. A reusable pressure stabilizer, intra-coronary shunts and a single posterior pericardial stitch exposure technique were used in all OPCAB cases. Non-randomized, retrospective data analysis included demographic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: During the study period 387 patients with LMS stenosis underwent surgery (OPCAB n = 75, CCAB n = 312). Groups were similar in terms of preoperative and intraoperative variables although CCAB patients received significantly more grafts per patient (3.1±0.73 vs. 2.6±0.76, P ≤ 0.001). Mortality was similar in both groups (OPCAB 1.3% vs. CCAB 2.6%). OPCAB patients when compared to CCAB patients had a lower requirement for postoperative inotropes (12.0% vs. 38.1%, P = 0.001), temporary postoperative pacing (2.7% vs. 10.1%, P ≤ 0.02), and blood product transfusion (6.7% vs. 31.4%, P < 0.001), a lower incidence of postoperative chest infection (0% vs. 6.7%, P = 0.01) and a slightly reduced postoperative length of stay (7.9±5.46 vs. 8.3±5.11 days, P = 0.01). At 24 months follow-up, CCAB and OPCAB actuarial survival was 94.1±1.7% and 97.7±2.3%, respectively. Conclusions: OPCAB surgery is safe and effective in patients with critical LMS disease.Keywords
This publication has 18 references indexed in Scilit:
- Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized studyThe Annals of Thoracic Surgery, 1999
- ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery: Executive Summary and RecommendationsCirculation, 1999
- On-pump versus off-pump coronary revascularization: evaluation of renal functionPublished by Elsevier ,1999
- Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized studyPublished by Oxford University Press (OUP) ,1999
- Off-pump multivessel coronary bypass via sternotomy is safe and effectiveThe Annals of Thoracic Surgery, 1998
- Coronary artery bypass grafting on the beating heart without the use of extracorporeal circulation: review of 2052 casesThe Journal of Thoracic and Cardiovascular Surgery, 1998
- Inflammatory response after myocardial revascularization with or without cardiopulmonary bypassThe Annals of Thoracic Surgery, 1998
- Coronary artery bypass grafting without cardiopulmonary bypassThe Annals of Thoracic Surgery, 1996
- Comparison of Surgical and Medical Group Survival in Patients With Left Main Equivalent Coronary Artery DiseaseCirculation, 1995
- Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery diseaseThe American Journal of Cardiology, 1981