title: Assessment of on-pump beating coronary artery bypass surgery performed after introduction of off-pump approach.
abstract: OBJECTIVE
  To clarify the position of on-pump beating coronary artery bypass (CAB) and to define preoperative indicators of intentional conversion to the procedure in the era of advancement of off-pump CAB (OPCAB), we assessed on-pump beating CAB performed after the introduction of OPCAB.
  
  
  METHODS
  We assessed 130 patients who underwent single CAB [117 (90%) with OPCAB and 13 (10%) with on-pump beating CAB] between August 1999 (when OPCAB was selected as the first-line surgical procedure) and December 2004.
  
  
  RESULTS
  No significant differences were seen between the groups in the number of coronary lesions or the prevalence of left main trunk (LMT) lesion. Reduced left cardiac function, cardiac dilatation, and mitral regurgitation (MR) were more remarkable in the on-pump beating CAB group. Preoperative ischemic condition was generally unstable in the both groups. A conversion to on-pump beating CAB occurred at anastomosis for the left anterior descending (LAD) branch in 61% and for the left circumflex (LCX) branch in 15%. LAD patients had more severe left cardiac dysfunction and cardiac dilatation than LCX patients.
  
  
  CONCLUSIONS
  To perform safe and reliable CAB surgery, cardiovascular surgeons should define preoperative indicators of difficult OPCAB and convert OPCAB to on-pump beating CAB intentionally without hesitation when unstable hemodynamics is detected.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan.
authors.forename: Takeshiro
authors.initials: T
authors.lastname: Fujii
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Noritsugu
authors.initials: N
authors.lastname: Shiono
authors.forename: Muneyasu
authors.initials: M
authors.lastname: Kawasaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yokomuro
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ozawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Masuhara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Teramoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Hara
authors.forename: Tomonori
authors.initials: T
authors.lastname: Katayanagi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Nobuya
authors.initials: N
authors.lastname: Koyama
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology