title: Total arterial revascularization in triple-vessel disease with off-pump and aortic no-touch technique.
abstract: BACKGROUND
  We evaluated the outcomes in patients who have undergone total arterial revascularization using the bilateral internal thoracic arteries (BITA) with off-pump and aorta no-touch technique.
  
  
  METHODS
  From March 2001 to September 2007, 512 consecutive patients with triple-vessel disease underwent total arterial revascularization with off-pump and aortic no-touch technique, using BITA or the right gastroepiploic artery (RGEA) in addition to BITA. Only BITA grafts were used for bypass to coronary arteries in 353 patients, and additionally in situ RGEA was bypassed to right coronary arteries in 159 patients. The mean number of distal anastomoses was 4.15 +/- 0.8 per patient.
  
  
  RESULTS
  One 30-day death occurred. Deep sternal wound infection occurred in 2 patients. The rate of perioperative stroke was 0.8%. The patients were followed for as long as 6 years (mean follow-up, 37.9 +/- 17.7 months). The 1-year and 5-year actuarial freedom from cardiac death was 98.3% and 96.7%, respectively. The 1-year and 5-year actuarial freedom from cardiac events was 97.1% and 89.3%, respectively. Using RGEA was a significant predictor of cardiac event-free survival (p = 0.046).
  
  
  CONCLUSIONS
  Total arterial revascularization using off-pump coronary bypass and aortic no-touch techniqe with BITA grafts was safe and effective, with low mortality among patients with triple-vessel disease. Patients undergoing in-situ RGEA grafting for right coronary arteries appeared to have fewer cardiac events than did patients undergoing only BITA grafting in triple-vessel disease.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.forename: Jaejin
authors.initials: J
authors.lastname: Lee
authors.forename: Young Tak
authors.initials: YT
authors.lastname: Lee
authors.forename: Kiik
authors.initials: K
authors.lastname: Sung
authors.forename: Ji-Hyuk
authors.initials: JH
authors.lastname: Yang
authors.forename: Tae-Gook
authors.initials: TG
authors.lastname: Jun
authors.forename: Pyo Won
authors.initials: PW
authors.lastname: Park
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000401:mortality*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D024405:Gastroepiploic Artery / Q000637:transplantation; D006085:Graft Survival; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome