title: Integrated approach to off-pump coronary artery bypass surgery.
abstract: BACKGROUND
  The Off-Pump Coronary Artery Bypass (OPCAB) technique is becoming more popular in many cardiac units throughout the world. This relatively new technique has prompted surgeons and anaesthetists to review and modify the routine approach to Coronary Artery Bypass Surgery (CABG). In this study we reviewed and analysed the outcome of an integrated anaesthetic and surgical peri-operative approach that allowed routine use of OPCAB and avoided the use of cardiopulmonary bypass (CPB).
  
  
  METHODS
  We reviewed and analysed the data on the first consecutive 285 patients who were operated on using the OPCAB technique. These represent our initial experience with applying the OPCAB technique non-selectively for all patients over a period of 16 months.
  
  
  RESULTS
  All patients had at least 2-vessel disease. 807 grafts were performed (mean 2.8 per patient) of which 647 (80%) were arterial (mean 2.3 per patient). 179 (63%) patients underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications--mortality 3 (1%); renal failure 24 (8%); stroke 3 (1%) and atrial fibrillation 60 (21%).
  
  
  CONCLUSIONS
  This retrospective analysis shows that provided a combined and integrated anaesthetic and surgical approach is used, beating heart technique for CABG can be safely offered to all patients with a good outcome.
authors.affiliation: The Royal Brompton and Harefield NHS Trust, Imperial College of Science, Technology and Medicine, Harefield Hospital, Middlesex UB9 6JH, UK.
authors.forename: S
authors.initials: S
authors.lastname: Al-Ruzzeh
authors.forename: M
authors.initials: M
authors.lastname: Amrani
authors.forename: M
authors.initials: M
authors.lastname: Boscoe
authors.forename: J
authors.initials: J
authors.lastname: Farrimond
authors.forename: B
authors.initials: B
authors.lastname: Riedel
authors.forename: I
authors.initials: I
authors.lastname: Wright
authors.forename: S
authors.initials: S
authors.lastname: George
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies