title: Off-pump versus on-pump reoperative CABG via a left thoracotomy for circumflex coronary artery revascularization.
abstract: OBJECTIVE
  Reoperative CABG via a left thoracotomy (RCLT) has become a useful approach for revascularization of the circumflex coronary territory for patients who are at high risk for conventional approach. This study compares the results of RCLT using cardiopulmonary bypass (CPB) with those of a beating heart technique (OPCAB).
  
  
  METHODS
  Thirty-two patients who underwent RCLT over the past 10 years were included. Fourteen patients undergoing on-pump RCLT (CPB) were compared to 18 patients undergoing off-pump RCLT (OPCAB). Baseline characteristics of the study groups were similar. Follow-up was 100% complete. A single graft was performed in all patients except one who had two grafts.
  
  
  RESULTS
  There were no deaths or perioperative myocardial infarctions in either group. The incidence of atrial fibrillation (CPB: 29% vs. OPCAB: 11%) and the percentage of patients requiring ventilator support longer than 24 hours (21% vs. 6%) was not significantly different between the groups. However, allogeneic blood product utilization (0.9 +/- 1.2 vs. 0.3 +/- 0.7 units, p = 0.04), ICU stay (65 +/- 79 vs. 28 +/- 16 hours, p = 0.04) and total hospital length of stay (8 +/- 4 vs. 5 +/- 1 days, p = 0.001) were significantly lower in the OPCAB group. Average follow-up for the entire cohort was 33 +/- 9.8 months (range 2-102 months). Three-year survival was 74 +/- 9% with 9 deaths (28%) during the follow-up, but only 3 (9%) were cardiac related. Reinterventions were indicated in 6 patients (19%) (PTCA; 5, CABG: 1). Follow-up was longer for the CPB group (51 +/- 33 vs. 19.5 +/- 14 months, p = 0.001). Three-year survival (CPB 69 +/- 13%, OPCAB: 82 +/- 12%, p = 0.47) and reintervention rates (CPB: 3 [21%], OPCAB: 3 [17%], p = 0.33) were similar between the groups.
  
  
  CONCLUSIONS
  RCLT is an effective and safe approach for circumflex artery revascularization with excellent short- and mid-term results using either technique. The OPCAB technique is associated with reduced blood product utilization and shorter ICU and hospital length of stay and, therefore, is more cost-effective.
authors.affiliation: Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA. oz.shapira@bmc.org
authors.forename: Oz M
authors.initials: OM
authors.lastname: Shapira
authors.forename: Vijay
authors.initials: V
authors.lastname: Natarajan
authors.forename: Shantesh
authors.initials: S
authors.lastname: Kaushik
authors.forename: Kolleen M
authors.initials: KM
authors.lastname: DeAndrade
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shemin
mesh_terms: D000368:Aged; D001900:Boston; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D016019:Survival Analysis; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome