title: Our experiences for off-pump coronary artery bypass grafting to the circumflex system.
abstract: BACKGROUND
  Complete revascularization has been difficult in off-pump coronary artery bypass grafting (OPCAB). Hemodynamic deterioration often prevents access to the circumflex territory. This study presents instrumentation for accessing the circumflex territory, and our clinical experience.
  
  
  METHODS
  From August 1999 through December 2002, 140 patients underwent OPCAB via sternotomy in our institution. The 114 requiring reconstruction of the circumflex artery are the subjects of this study. There were no exclusion criteria. A series of techniques and instruments were developed to provide access to the circumflex area while hemodynamic stability was preserved, including the left pericardial traction technique, compression of the right pericardium, a right sternal retractor, and a type of shunt tube.
  
  
  RESULTS
  Patients received an average of 3.2 grafts (range, 2 to 6). Complete revascularization was achieved in 95% of the cases. Complications included respiratory insufficiency (0.8%), renal dysfunction (7%), and sternal wound infection (0.8%). Blood transfusions were required in 10 patients (8%). No patient suffered perioperative myocardial infarction or stroke. No operation was converted to cardiopulmonary bypass. There was no operative death. Predischarge angiography demonstrated a 99% patency rate.
  
  
  CONCLUSIONS
  With our techniques and instruments, off-pump coronary revascularizaion of the circumflex area may be performed safely to achieve complete revascularization. Early clinical results are excellent, but long-term longitudinal follow-up is required to assess the future effectiveness of OPCAB procedure with our techniques.
authors.affiliation: Kochi Municipal Hospital, Kochi, Japan. suzukit@bronze.ocn.ne.jp
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Manabu
authors.initials: M
authors.lastname: Okabe
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Yasuda
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Mitsuteru
authors.initials: M
authors.lastname: Handa
authors.forename: Takazumi
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications