Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study.
BACKGROUND
We investigated whether off-pump coronary artery bypass (OPCAB) surgery should be the procedure of choice in total arterial myocardial revascularization with composite grafts.


METHODS
We prospectively enrolled 176 patients undergoing total arterial myocardial revascularization and assigned them at random to one of two groups: group 1 was composed of 88 patients undergoing coronary surgery with cardiopulmonary bypass (CPB); group 2 consisted of 88 patients receiving the OPCAB procedure. We excluded from this study patients with significant risk factors for CPB-related morbidity. Composite arterial grafts in Y-T shape were realized in three different configurations according to patients' characteristics, coronary anatomy, and target stenosis.


RESULTS
There were no significant differences between the two groups in terms of preoperative characteristics and risk factors (Euroscore: group 1 = 6.1 +/- 3.5, group 2 = 6.6 +/- 3.8). Mean number of anastomoses was similar in both groups (group 1 = 2.8 +/- 0.8, group 2 = 2.7 +/- 0.5) whereas mean mechanical ventilation time (group 1 = 23 +/- 9 hours, group 2 = 9 +/- 4 hours), intensive care unit stay (group 1 = 43 +/- 6 hours, group 2 = 22 +/- 8 hours), and postoperative stay (group 1 = 7 +/- 3 days, group 2 = 5 +/- 2 days) were significantly reduced in group 2. Early mortality was 2.3% in group 1 and 3.4% in group 2 (p = not significant). Major postoperative complications occurred similarly in the two groups (atrial fibrillation: group 1 = 35.2%, group 2 = 21.6%; myocardial infarction: group 1 = 2.2%, group 2 = 1.1%; stroke: group 1 = 2.2%, group 2 = 0%; abdominal infarction: group 1 = 3.4%, group 2 = 0%). At follow-up (mean, 15 +/- 12 months) no significant differences were observed in terms of survival free of any cardiac-related event (group 1 = 94.3%, group 2 = 96.5%; p = not significant).


CONCLUSIONS
Off-pump coronary artery surgery could be successfully used for total arterial grafting without compromising the completeness of revascularization. Avoidance of CPB significantly decreased mechanical ventilation support and length of intensive care unit and postoperative stay; however in the absence of risk factors for cardiopulmonary bypass, off-pump coronary artery surgery did not improve early and midterm clinical outcome.
Muneretto
Claudio
C
division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy. munerett@master.cci.unibs.it
Bisleri
Gianluigi
G
Negri
Alberto
A
Manfredi
Jacopo
J
Metra
Marco
M
Nodari
Savina
S
Dei Cas
Livio
L
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors