title: Perioperative patency of coronary artery bypass grafting is not influenced by off-pump technique.
abstract: BACKGROUND
  Some concerns have been raised about technical accuracy and quality of distal anastomoses in off-pump myocardial revascularization (OPCAB), which could affect graft patency.
  
  
  METHODS
  Transit-time flowmetric results and clinical, enzymatic, and echocardiographic findings from 201 consecutive isolated on-pump coronary artery bypass graft cases (cardiopulmonary bypass coronary artery bypass grafting; group A) were compared with 96 consecutive OPCAB (group B) cases performed at our institution between January 2003 and December 2004. Maximum, mean, minimum flow, and pulsatility index were compared, stratifying the two groups according to graft type and coronaries revascularized. Graft flow reserve was evaluated in patients undergoing preoperative intraaortic balloon pump during baseline conditions and at a 1 to 1 ratio of intraaortic balloon pump augmentation.
  
  
  RESULTS
  No differences were recorded between the two groups in hospital mortality, perioperative myocardial infarction, postoperative enzymatic leakage, echocardiographic recovery, or hospital stay (p = not significant). Off-pump coronary artery bypass and cardiopulmonary bypass coronary artery bypass grafting demonstrated similar intraoperative maximum (75.8 +/- 10.4 mL/min vs 82.3 +/- 15.8; p = 0.190), mean (50.1 +/- 13.3 vs 46.3 +/- 7.7; p = 0.420), minimum flow (12.7 +/- 5.3 vs 11.9 +/- 5.4; p = 0.811), and pulsatility index (2.9 +/- 0.2 vs 2.6 +/- 0.8; p = 0.360). After stratifying the population according to graft type, no differences were detected between the two groups in transit-time flowmetric results of left internal mammary artery, radial artery, and single and sequential saphenous vein grafts. A one to one ratio of intraaortic balloon pump augmentation did not result in any difference in graft flow reserve when left internal mammary artery (p = 0.699), radial artery (p = 0.066), and saphenous vein graft anastomoses (p = 0.772) were considered.
  
  
  CONCLUSIONS
  Off-pump coronary artery bypass grafting and cardiopulmonary bypass coronary artery bypass grafting demonstrated similar clinical, biochemical, and transit-time flowmetric results, as well as comparable graft flow reserve. These data exclude a lower anastomotic quality in off-pump coronary artery bypass grafting.
authors.affiliation: Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy. frankono@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Silvio
authors.initials: S
authors.lastname: Olivito
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mastroroberto
authors.forename: Antonio
authors.initials: A
authors.lastname: di Virgilio
authors.forename: Antonio
authors.initials: A
authors.lastname: Esposito
authors.forename: Andrea
authors.initials: A
authors.lastname: Perrotti
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014654:Vascular Patency