title: Multivessel off-pump revascularization in patients with significant left main coronary artery stenosis: early and midterm outcome analysis.
abstract: BACKGROUND
  The presence of significant left main stenosis (> or =50%) has been considered a relative contraindication to the use of off-pump coronary artery bypass (OPCAB) stemming from well-documented hemodynamic perturbations during the displacement of the heart. We examined our experience with patients with critical left main stenosis (LMS) to assess the safety and feasibility of OPCAB in this subgroup.
  
  
  METHODS
  Our prospectively updated database was queried to identify all patients with severe left main disease who underwent isolated coronary revascularization between January 1, 1999 and May 31, 2002. This query yielded 234 on-pump and 420 off-pump patients with significant LMS whose clinical information was retrospectively reviewed.
  
  
  RESULTS
  The groups were well matched with regard to gender, left ventricular function, surgical priority, and severity of angina. The conventional coronary artery bypass (CABG) group was significantly younger than the OPCAB group and had a higher incidence of a previous myocardial infarction. Patients in the CABG cohort were more likely than OPCAB patients to remain ventilated after 24 hours, require placement of intraoperative or postoperative intraaortic balloon pump, or suffer from postoperative renal failure. There was a decrease in mortality (6.4% vs. 1.9%; p = 0.006) when CPB was eliminated. Intermediate term survival analysis revealed a significant survival benefit in the off-pump group (p = 0.007).
  
  
  CONCLUSIONS
  Multivessel off-pump revascularization in patients with severe left main disease is a safe and effective alternative to conventional bypass grafting and conveys a survival benefit.
authors.affiliation: Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, NJ 07112, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Beauford
authors.forename: Craig R
authors.initials: CR
authors.lastname: Saunders
authors.forename: Troy Adam
authors.initials: TA
authors.lastname: Lunceford
authors.forename: Leo A
authors.initials: LA
authors.lastname: Niemeier
authors.forename: Shamji
authors.initials: S
authors.lastname: Shah
authors.forename: Ravindra
authors.initials: R
authors.lastname: Karanam
authors.forename: Thomas
authors.initials: T
authors.lastname: Prendergast
authors.forename: Paul
authors.initials: P
authors.lastname: Burns
authors.forename: Frederick
authors.initials: F
authors.lastname: Sardari
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery*; D019992:Databases as Topic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome