title: The early clinical and angiographic outcome of sequential coronary artery bypass grafting with the off-pump technique.
abstract: OBJECTIVE
  The emergence of the off-pump coronary artery bypass technique has made surgeons consider combining it with other techniques developed and learned with conventional coronary artery bypass grafting with cardiopulmonary bypass. One of these techniques is the construction of a sequential graft to bypass more than one coronary vessel. The purpose of this study is to review the outcome of combining sequential coronary artery bypass grafting with off-pump techniques.
  
  
  METHODS
  We retrospectively reviewed the records of 45 consecutive patients who underwent isolated coronary bypass surgery with off-pump and sequential grafting techniques at Harefield Hospital (Harefield, UK) between July 1999 and December 2000. The registry database, medical notes and charts were studied for preoperative and postoperative data of the patients. Ten patients consented and underwent early postoperative angiography to check the quality of the grafts and anastomoses.
  
  
  RESULTS
  There were no deaths among the study patients. Morbidity consisted of atrial fibrillation in 6 patients (13.3%), leg wound infection in 2 patients (4.4%), and pleural effusion in 1 patient (2.2%). Early angiography of the 10 consenting patients revealed 10 patent sequential grafts (100%) with 20 satisfactory end-to-side and side-to-side anastomoses (100%).
  
  
  CONCLUSIONS
  The combination of sequential grafting and off-pump techniques is feasible, is safe, and provides good early clinical and angiographic outcomes.
authors.affiliation: Department of Cardiothoracic Surgery, National Heart and Lung Institute, Harefield Hospital, Harefield, Middlesex UB9 6JH, United Kingdom.
authors.forename: Sharif
authors.initials: S
authors.lastname: Al-Ruzzeh
authors.forename: Shane
authors.initials: S
authors.lastname: George
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Bustami
authors.forename: Koki
authors.initials: K
authors.lastname: Nakamura
authors.forename: Shahid
authors.initials: S
authors.lastname: Khan
authors.forename: Magdi
authors.initials: M
authors.lastname: Yacoub
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome