title: Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study.
abstract: 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.
authors.affiliation: division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy. munerett@master.cci.unibs.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Muneretto
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bisleri
authors.forename: Alberto
authors.initials: A
authors.lastname: Negri
authors.forename: Jacopo
authors.initials: J
authors.lastname: Manfredi
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: 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