title: [Myocardial revascularization via a median sternotomy without cardiopulmonary bypass in 250 patients--midterm results and study of graft patency].
abstract: OBJECTIVE
  To evaluate mid-term results and one-year graft patency of less invasive coronary artery bypass grafting through a median sternotomy.
  
  
  METHODS
  From January 1, 1998, to December 31, 1999, 250 patients had coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) through a median sternotomy. The patient base of 188 men and 62 women averaged 61.7 years, mean ejection fraction (EF) was 55.1%. An average of 2.7 (range 1 to 5) distal anastomoses per patient was achieved. Results are compared with a CPB subgroup of patients operated on through a median sternotomy in the same time (N = 1126). In a random subgroup of 100 patients (50 per group) an angiographic control of graft patency was done.
  
  
  RESULTS
  A non-CPB group showed lesser occurrence of postoperative acute myocardial infarction (p = 0.038), atrial fibrillation (p = 0.029) and lower incidence of renal (p = 0.033) complications. We observed lower operative mortality (p = 0.019), as well as the occurrence of low cardiac output syndrome (p < 0.001) in the off pump group. The follow-up is 36 +/- 12 months and the number of patients with recurrent angina (5.4%), late AMI (0%) and late death (0.4%) is acceptable. We did not find an inordinate number of vein grafts occlusions (2.2%) and stenoses (7.8%) at anastomotic sites. None of the arterial grafts in both groups were occluded.
  
  
  CONCLUSIONS
  We detected lower incidence of postoperative complications and decreased operative mortality in a non-CPB group. Angiographic assessment displayed an excellent run-off in both groups of patients. Off-pump coronary bypass grafting is associated with sufficient short-term graft patency and mid-term clinical outcomes.
authors.affiliation: II. chirurgická klinika kardiovaskulární chirurgie VFN a 1. LF UK, Praha. semrad@post.cz
authors.forename: M
authors.initials: M
authors.lastname: Semrád
authors.forename: J
authors.initials: J
authors.lastname: Lindner
authors.forename: M
authors.initials: M
authors.lastname: Stríteský
authors.forename: V
authors.initials: V
authors.lastname: Vondrácek
authors.forename: J
authors.initials: J
authors.lastname: Kristof
authors.forename: J
authors.initials: J
authors.lastname: Rohác
authors.forename: P
authors.initials: P
authors.lastname: Bodlák
authors.forename: K
authors.initials: K
authors.lastname: Novotný
authors.forename: I
authors.initials: I
authors.lastname: Miler
authors.forename: I
authors.initials: I
authors.lastname: Vanĕk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013249:Sternum / Q000601:surgery*; D014654:Vascular Patency