Total arterial revascularization for multiple vessel coronary artery disease: with or without cardiopulmonary bypass.
BACKGROUND
To assess the usefulness of off-pump technique for more technically demanding coronary artery bypass procedures using exclusively arterial conduits.


METHODS
Analysis of perioperative data of 324 consecutive patients in whom total arterial revascularization for multiple- vessel coronary artery disease was performed--181 cases on-pump and 143 cases off-pump.


RESULTS
On average in the on-pump group 2.7 +/- 0.8 (range, 2-5) grafts per patient were constructed versus 2.4 +/- 0.7 (range, 2-4) grafts per patient in the off-pump group (P < .001). Of the total number of 490 anastomoses performed on-pump, 83 (17%) were side-to-side and of 349 anastomoses performed off-pump, 51(15%) were side-to-side, a nonsignificant difference (P = .4). The aorta was used as a site for proximal anastomosis of 1 or more arterial conduits in 105 patients (58%) who underwent on-pump surgery and in 57 patients (40%) who underwent off-pump surgery (P = .002). In the off-pump group, the right internal thoracic artery (RITA) was rarely (12%) routed through the transverse sinus to circumflex branches compared with the on-pump group (34%) (P = .017). RITA in off-pump patients was more often used to revascularize the anterior wall (47% versus 29%; P = .08). We observed no difference in mortality (1.7% versus 0%; P = .3), incidence of perioperative myocardial infarction (8.8% versus 7.7%; P = .8), stroke (1.7% versus 1.4%; P = .8), or atrial fibrillation (24% versus 19%; P = .3). We observed less inotropic support and less blood-product use in off-pump patients.


CONCLUSIONS
Total arterial revascularization for multiple-vessel coronary artery disease may be safely performed off-pump. We observed tendency to somewhat smoother postoperative course in the off-pump group.
Deja
Marek A
MA
2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland. narizol@slam.katowice.pl
Widenka
Kazimierz
K
Duraj
Piotr
P
Jasinski
Marek
M
Bachowski
Ryszard
R
Mrozek
Roman
R
Gocol
Radoslaw
R
Hudziak
Damian
D
Golba
Krzysztof S
KS
Biernat
Jolanta
J
Wos
Stanislaw
S
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome