Conversion to off-pump coronary bypass without increased morbidity or change in practice.
BACKGROUND
This article examines the feasibility of complete conversion from conventional coronary artery operation to routine off-pump coronary bypass operation.


METHODS
Data on our first 285 off-pump procedures using the Octopus system (Medtronic Inc, Minneapolis, MN) represent our learning curve. This is a complete experience in coronary bypass surgery over 16 months.


RESULTS
The cohort was nonselected. All patients had at least two-vessel disease. Eight hundred seven grafts were performed (mean, 2.8 per patient) of which 647 grafts (84%) were arterial (mean, 2.3 per patient). One hundred seventy nine patients (63%) underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications were: mortality, 3 patients (1.5%); renal failure, 24 patients (8%); stroke, 2 patients (< 1%); and atrial fibrillation, 60 patients (21%). The morbidity data and frequency of arterial grafting did not differ from that of 355 patients who underwent coronary bypass operations in a preceding 18-month period.


CONCLUSIONS
Complete shift from routine use of cardiopulmonary bypass to nonselective off-pump coronary bypass operation is possible with a low conversion rate and without an apparent increase in morbidity or change in technique. Whereas short-term safety and efficacy seem certain, studies of long-term outcome are necessary before the eventual role of off-pump coronary bypass in myocardial revascularization can be defined.
Anyanwu
Ani C
AC
Harefield Hospital, Uxbridge, Middlesex, United Kingdom.
Al-Ruzzeh
Sharif
S
George
Shane J
SJ
Patel
Rikin
R
Yacoub
Magdi H
MH
Amrani
Mohamed
M
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016896:Treatment Outcome