Off-pump coronary artery bypass with complete avoidance of aortic manipulation.
BACKGROUND
Off-pump coronary artery bypass (OPCAB) with complete avoidance of aortic manipulation may further reduce perioperative morbidity in addition to the benefits achieved by avoiding cardiopulmonary bypass and cardioplegic arrest.


METHODS
We prospectively analyzed 222 consecutive patients with multivessel disease who underwent OPCAB without aortic manipulation (group I), and compared them with 123 consecutive patients who underwent OPCAB using additional free arterial or saphenous vein grafts that were anastomosed on the ascending aorta (group II) and 76 consecutive patients who underwent on-pump conventional coronary artery bypass grafting (group III).


RESULTS
No significant differences were noted in operative mortalities among the three groups (2/222, 3/123, and 2/76 in groups I, II, and III, respectively; p = NS). Fewer distal anastomoses were done in group I compared with groups II and III (3.2 +/- 0.9, 3.5 +/- 0.8, and 3.7 +/- 0.9 in groups I, II, and III, respectively; p < 0.001). No differences were noted in the incidences of postoperative morbidities such as mediastinitis, pulmonary complication, and reoperation for bleeding. The incidences of stroke, atrial fibrillation, and acute renal failure were significantly lower in group I than in group III (p < 0.05), although there were no significant differences between groups II and III. The incidence of perioperative myocardial infarction was significantly lower in group I than in groups II and III (p < 0.05), although there was no significant difference between groups II and III.


CONCLUSIONS
Our results demonstrate that OPCAB with complete avoidance of aortic manipulation may further reduce the incidence of perioperative morbidities such as stroke, atrial fibrillation, acute renal failure, and perioperative myocardial infarction.
Kim
Ki-Bong
KB
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, South Korea. kimkb@snu.ac.kr
Kang
Chang Hyun
CH
Chang
Woo-Ik
WI
Lim
Cheong
C
Kim
Jin Hee
JH
Ham
Byung Moon
BM
Kim
Yong Lak
YL
D058186:Acute Kidney Injury / Q000517:prevention & control; D001011:Aorta / Q000601:surgery; D001158:Arteries / Q000601:surgery; D001281:Atrial Fibrillation / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D012501:Saphenous Vein / Q000601:surgery