title: Off-pump bypass grafting is safe in patients with left main coronary disease.
abstract: BACKGROUND
  Because of a concern about the ability to tolerate beating heart grafting, patients with left main coronary artery stenosis have been excluded from off-pump bypass. We reviewed our experience with off-pump coronary artery bypass grafting for patients with left main coronary artery disease.
  
  
  METHODS
  Eight hundred twenty-three patients underwent bypass grafting for left main coronary artery disease from January 1998 to October 1999. One hundred patients were revascularized without the use of cardiopulmonary bypass and compared with a contemporaneous cohort of 723 patients who underwent grafting with the aid of cardiopulmonary bypass. All patients had multivessel grafting performed through a sternotomy.
  
  
  RESULTS
  There was one death (1%) in the group undergoing off-pump grafting as compared with a 30-day mortality of 4.7% (p = 0.059) in the on-pump group. Univariate analysis established that patients revascularized without cardiopulmonary bypass were significantly less likely to require postoperative inotropic support (23% versus 62%, p < 0.001) and transfusion (35% versus 67%, p < 0.001). Logistic regression analysis revealed that cardiopulmonary bypass was an independent risk factor for mortality (odds ratio, 7.3; 95% confidence interval, 1.34 to 138.4).
  
  
  CONCLUSIONS
  Coronary artery bypass grafting using off-pump techniques are safe and effective in left main coronary artery disease.
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. tdewey@csant.com
authors.forename: T M
authors.initials: TM
authors.lastname: Dewey
authors.forename: M J
authors.initials: MJ
authors.lastname: Magee
authors.forename: J R
authors.initials: JR
authors.lastname: Edgerton
authors.forename: M
authors.initials: M
authors.lastname: Mathison
authors.forename: D
authors.initials: D
authors.lastname: Tennison
authors.forename: M J
authors.initials: MJ
authors.lastname: Mack
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors