title: Rationale of off-pump coronary artery bypass grafting for left main trunk disease.
abstract: OBJECTIVE
  Off-pump coronary artery bypass grafting (OPCAB) remains controversial in patients with left main trunk (LMT) disease because of a concern about the ability to tolerate hemodynamic instability. This study examined the safety of OPCAB for LMT disease compared with conventional coronary artery bypass grafting (CABG).
  
  
  METHODS
  Between April 1997 and December 2002, 257 consecutive patients with LMT stenosis who underwent CABG were enrolled. There were 98 patients who received CABG with the aid of cardiopulmonary bypass (CCAB group), and 159 patients who received OPCAB (OPCAB group).
  
  
  RESULTS
  There was no patient who converted to on-pump intraoperatively due to hemodynamic instability. Both intraoperative blood loss and blood transfusion incidence were lower in the OPCAB group. Postoperative course was similar, however, pulmonary complications were less observed postoperatively in the OPCAB group. No hypoperfusion syndrome was seen postoperatively in both groups. The average number of anastomosis was 3.2+/-1.1 in the CCAB group and 3.2+/-1.0 in the OPCAB group (p=0.645). Total arterial OPCAB with an aorta no-touch technique was achieved in 142 patients (89.3%) in OPCAB group. Postoperative angiography was performed in 95 patients in CCAB (96.9%), and in 141 patients in OPCAB (89.8%). Although graft patency of arterial grafts was good in both groups (100% in CCAB and 98.3% in OPCAB), saphenous vein graft patency was slightly lower in both groups (93.4% in CCAB and 76.5% in OPCAB) compared with arterial grafts.
  
  
  CONCLUSIONS
  OPCAB allows a safe and effective treatment of LMT disease.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
authors.forename: Satsuki
authors.initials: S
authors.lastname: Fukushima
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Tagusari
authors.forename: Ko
authors.initials: K
authors.lastname: Bando
authors.forename: Kazuo
authors.initials: K
authors.lastname: Niwaya
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Michiko
authors.initials: M
authors.lastname: Ishida
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000592:standards / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014654:Vascular Patency