Off-pump coronary surgery in a single center experience: from selective to systematic use.
BACKGROUND
The feasibility of the systematic use of the off-pump technique for myocardial revascularization was investigated.


METHODS
From September 1997 to June 2001, 1221 isolated coronary artery bypass grafting operations were performed consecutively: 771 (group A) were completed with cardiopulmonary bypass, and 450 (group B) without. Since July 2000 all patients were considered as potential candidates for off-pump coronary artery bypass. In group B, a specific original instrumentation was used for coronary stabilization.


RESULTS
The differences in the preoperative data were: a higher age, a higher incidence of chronic obstructive pulmonary disease and a left ventricular ejection fraction < 30% in group B; a higher incidence of critical left main stenosis in group A. More grafts per patient were completed in group A (3.0 +/- 1.4 vs 2.2 +/- 0.9, p < 0.001). The hospital mortality (group A 1.0%, group B 0.7%) and the incidence of perioperative myocardial infarction (group A 2.5%, group B 1.1%) and that of cerebrovascular accidents (group A 1.4%, group B 0.9%) were comparable. Bleeding (610 +/- 370 vs 496 +/- 215 ml, p < 0.001), the transfusion rate (36 vs 19.7%, p < 0.001), the intubation time (13.4 +/- 3.5 vs 8.3 +/- 5 hours, p < 0.001), the intensive care unit stay (1.7 +/- 2.7 vs 1.2 +/- 2.1 days, p < 0.001) and the hospital stay (5.8 +/- 3 vs 5.1 +/- 3.2 days, p < 0.001) were lower in group B. At follow-up, the mortality (2.5 vs 1.1%), the rate of recurrence of angina (2.5 vs 2.0%), and those of re-angiography (4.1 vs 5.3%) and of new revascularization (1.6 vs 1.1%) were similar. The actuarial survival rates were 99.8, 98.6 and 96.3% in group A, and 98.8, 96.7 and 96.7% in group B at 1, 2 and 3 years of follow-up respectively (log rank p = 0.3387).


CONCLUSIONS
The increase in the use of off-pump coronary artery bypass up to its systematic empolyment is feasible. The early and intermediate results are satisfactory.
Troise
Giovanni
G
Cardiac Surgery Unit, Poliambulanza Hospital, Brescia, Italy. cch-segreteria.poli@poliambulanza.it
Brunelli
Federico
F
Cirillo
Marco
M
Dalla Tomba
Margherita
M
Tasca
Giordano
G
Mhagna
Zen
Z
Danzi
Gian Battista
GB
Amari
Bruno
B
Quaini
Eugenio
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006355:Heart-Lung Machine; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D015996:Survival Rate