Assessment of on-pump beating coronary artery bypass surgery performed after introduction of off-pump approach.
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.
Fujii
Takeshiro
T
Division of Cardiovascular Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan.
Watanabe
Yoshinori
Y
Shiono
Noritsugu
N
Kawasaki
Muneyasu
M
Yokomuro
Hiroki
H
Ozawa
Tsukasa
T
Hamada
Satoshi
S
Masuhara
Hiroshi
H
Teramoto
Tetsuo
T
Hara
Masanori
M
Katayanagi
Tomonori
T
Sasaki
Yuki
Y
Koyama
Nobuya
N
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