title: Off-pump coronary artery bypass grafting: single center experience with 1,000 consecutive patients.
abstract: BACKGROUND
  Advances in surgical techniques and retractor-stabilizer devices allowing access to all coronary segments have resulted in increased interest in off-pump coronary artery bypass. The residual motion in the anastomotic site and potential hemodynamic derangements, however, render this operation technically more demanding.
  
  
  OBJECTIVE
  To evaluate the OPCAB experience in a single Israeli center.
  
  
  METHODS
  Between 2000 and 2003 in our institution, 1,000 patients underwent off-pump operations. Patients were grouped by the type of procedure, i.e., minimally invasive direct coronary artery bypass or mid-sternotomy OPCAB.
  
  
  RESULTS
  One hundred MIDCAB operations were performed. Of the 900 OPCAB, 767 patients received multiple grafts with an average of 2.6 +/- 0.6 grafts per patient (range 2-4) and the remaining patients underwent single grafting during hybrid or emergency procedures. In the multiple-graft OPCAB group, complete revascularization was achieved in 96%. Multiple arterial conduits were used in 76% of the patients, and total arterial revascularization without aortic manipulation, using T-graft (35%) or in situ configurations, was performed in 61%. The respective rates for early mortality, myocardial infarction and stroke in the MIDCAB were 1%, 0% and 2%, and 2%, 1.3% and 0.9% in the multiple-vessel OPCAB groups. Multivariate analysis identified renal dysfunction (odds ratio 11.5, confidence interval 3.02-43.8; P < 0.0001) and emergency operation (OR 8.74, CL 1.99-38.3; P = 0.004) as predictors of mortality. The proportion of off-pump procedures increased from 9% prior to the study period to 59%.
  
  
  CONCLUSIONS
  The use of OPCAB does not compromise the ability to achieve complete myocardial revascularization. Our procedure of choice is OPCAB using arterial conduits, preferably the 'no-touch' aorta technique.
authors.affiliation: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. orenlevran@hotmail.com
authors.forename: Oren
authors.initials: O
authors.lastname: Lev-Ran
authors.forename: Dmitri
authors.initials: D
authors.lastname: Pevni
authors.forename: Nahum
authors.initials: N
authors.lastname: Nesher
authors.forename: Ram
authors.initials: R
authors.lastname: Sharony
authors.forename: Yosef
authors.initials: Y
authors.lastname: Paz
authors.forename: Amir
authors.initials: A
authors.lastname: Kramer
authors.forename: Rephael
authors.initials: R
authors.lastname: Mohr
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D013249:Sternum / Q000601:surgery