title: Use of off-pump coronary artery bypass surgery among patients with malignant disease.
abstract: BACKGROUND
  Patients undergoing coronary artery surgery associated with malignant disease are high-risk patients. The surgical strategy among these patients remains controversial. We present our experience of using a two-staged surgical strategy of managing coronary artery disease using off-pump bypass followed by tumor management.
  
  
  METHODS
  During a six-year period from 2002 to 2007, 350 patients underwent myocardial revascularization using off-pump bypass. Among these patients, associated malignant disease was found in six patients (1.7%). Two of them had papillary carcinoma of the bladder, one patient had chronic lymphocytic leukemia, and the rest suffer from carcinoma affecting the prostate, colon, and right lung. Their mean age was 54 years. Their data was evaluated. Patients were followed up to evaluate their symptoms and progress of their disease.
  
  
  RESULTS
  All patients were managed successfully. Complete revascularization was achieved in all patients except one due to small nongraftable vessels. The mean number of grafts was 1.8 +/- 0.8. There was no evidence of postoperative infraction or stroke. The mean hospital stay was 5 +/- 1.1 days. Management of cancer was done during the same hospital admission in two patients with bladder cancer. The rest had a mean interval of 6.6 +/- 5.4 days. Two patients underwent surgery in the form of left hemicolectomy and right lower lobectomy. The rest had chemotherapy as a sole treatment. All patients were followed up completely for a period of 12 to 84 months (mean 39.2 +/- 26.7 months). We had no late mortality. All patients remained asymptomatic except one, who had angina of class III and had recurrence of her bladder tumor, which necessitated two sessions of endoscopic resection.
  
  
  CONCLUSIONS
  We believe that staged operation to treat coronary artery disease and malignancy can be performed safely. The use of off-pump technique to revascularize the myocardium can be performed without any complications.
authors.affiliation: Department of Cardiac Surgery, Makassed Hospital, Mount of Olives, Jerusalem, Israel. darwaz30@hotmail.com
authors.forename: Ahmad K
authors.initials: AK
authors.lastname: Darwazah
authors.forename: Mohamed
authors.initials: M
authors.lastname: Osman
authors.forename: Barakat
authors.initials: B
authors.lastname: Sharabati
mesh_terms: D000328:Adult; D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D011183:Postoperative Complications; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left