Early and late outcome after off-pump coronary artery bypass graft surgery with coronary endarterectomy: a single-center 10-year experience.
BACKGROUND
We aimed to review the early and late results of off-pump coronary artery bypass graft surgery (OPCABG) with coronary endarterectomy in patients undergoing surgical revascularization at our institution.


METHODS
Between 1995 and 2004, of 680 OPCABG patients in a single surgeon's practice (W.R.D.), 70 patients (10.29%) who underwent concomitant coronary endarterectomy were studied. The mean age was 63.6 +/- 9.29 years. Thirty-three patients (55%) were Canadian Cardiovascular Society class III or IV, and 24 patients (40%) were New York Heart Association class III or IV. Eighteen patients (35%) had impaired left ventricular function. The mean EuroSCORE of these patients was 5.9 +/- 1.8.


RESULTS
Fifty-seven patients (81%) underwent right coronary artery endarterectomy, and 12 patients (17%) underwent left anterior descending artery endarterectomy (8 left interior mammary arteries used as conduits). Four patients (5.7%) had two vessels endarterectomized. The mean number of grafts were 2.0 +/- 0.4. The 30-day mortality rate was 2.85% (n = 2). Three patients (4.3%) suffered from postoperative myocardial infarction, and 3 patients (4.3%) required postoperative intra-aortic balloon pump counterpulsation. Mean intensive therapy unit stay was 17.6 +/- 8.1 hours. Patients were extubated after a mean of 10.38 +/- 4.9 hours. The mean length of hospital stay was 6.1 +/- 2.0 days. Fourteen patients (20%) had postoperative atrial fibrillation, and only 1 patient (1.42%) had a transient stroke with complete recovery. There were no conversions to cardiopulmonary bypass. A mean of 0.86 +/- 0.17 units of blood were transfused postoperatively. There was one reopening for bleeding, and 1 patient had renal failure requiring hemofiltration. The median follow-up was 4.91 years, 90% of patients were angina free, and the actuarial survival at 10 years was 78.04% +/- 7.6%.


CONCLUSIONS
Off-pump coronary artery bypass graft survery with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse coronary artery disease.
Vohra
Hunaid A
HA
Department of Cardiothoracic Surgery, Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry, United Kingdom.
Kanwar
Raj
R
Khan
Tanveer
T
Dimitri
Wade R
WR
D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003331:Coronary Vessels / Q000601:surgery*; D004691:Endarterectomy / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome