Total arterial off-pump coronary artery bypass grafting for revascularization of the total coronary system: clinical outcome and angiographic evaluation.
BACKGROUND
We assessed the clinical outcome and conducted an angiographic study of total arterial off-pump coronary artery bypass grafting for revascularization of the total coronary system.


METHODS
Of 382 consecutive patients who underwent off-pump coronary artery bypass between April 2000 and December 2002, 235 patients (193 men and 42 women, mean age 66 +/- 9 years) with three-vessel disease underwent off-pump coronary artery bypass with all arterial grafts. A total of 872 vessels were bypassed (average number of grafts 3.7 +/- 0.8). The internal thoracic arteries, radial arteries, and gastroepiploic arteries were used for revascularization of 306, 542, and 24 coronary arteries, respectively. Two hundred twenty-five patients underwent revascularization with composite grafts that were connected to the in situ internal thoracic artery (Y configuration 181, I configuration 55, K configuration 27, X configuration 3, T configuration 1); 10 patients underwent revascularization with all in situ grafts.


RESULTS
Three (1.3%) hospital deaths and 1 late death occurred. There were no occurrences of clinical underperfusion syndrome or new intraaortic balloon pump insertion. Cerebral infarction occurred in 2 patients (0.8%). Early postoperative angiography was performed on 833 grafts in 223 patients (95%); the overall patency rate was 98%. Stratified by coronary distribution, the patency rate was 99% (218/221) in the left anterior descending artery, 97% (84/87) in the diagonal artery, 99% (70/71) in the obtuse marginal artery, 98% (262/268) in the posterolateral artery, 98% (167/170) in the posterior descending artery, and 100% (16/16) in the right coronary artery.


CONCLUSIONS
Total arterial off-pump coronary artery bypass yielded good clinical results and an excellent patency rate of revascularization for the total coronary system.
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. otagusar@hsp.ncvc.go.jp
Osamu
O
Tagusari
Junjiro
J
Kobayashi
Ko
K
Bando
Kazuo
K
Niwaya
Hiroyuki
H
Nakajima
Takeshi
T
Nakatani
Toshikatsu
T
Yagihara
Soichiro
S
Kitamura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000453:epidemiology; D015897:Comorbidity; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D023921:Coronary Stenosis / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000637:transplantation; D012189:Retrospective Studies; D013895:Thoracic Arteries / Q000000981:diagnostic imaging / Q000637:transplantation; D016896:Treatment Outcome; D014654:Vascular Patency