title: Off-pump coronary bypass grafting is safe and efficient in patients with left main disease and higher EuroScore.
abstract: BACKGROUND
  Summary Left main disease (LMD) and associated cardiac risk factors are often perceived as a limiting factor for the outcome of off-pump coronary artery bypass (OPCAB) grafting. In this study, we assess whether the outcome of OPCAB surgery is affected in such patients.
  
  
  METHODS
  We retrospectively compared perioperative parameters in 66 OPCAB patients (group A) with LMD and 216 OPCAB patients without (group B) LMD. The patients were operated in the time frame between 2002 and 2007. LMD was defined as a stenosis >50%.
  
  
  RESULTS
  Patients in group A had a higher EuroSCORE (logistic: 3.7+/-0.1 vs 6.3+/-0.3, p=0.027), increased coronary artery disease (CAD) family history (p=0.015) and cerebrovascular accidents (p=0.027), increased history of congestive heart failure (p=0.013), more urgent surgery (p=0.008), previous percutaneous transluminal coronary angioplasties (PTCAs) (p=0.05) and previous stent implantation (p=0.023). An intra-aortic balloon pump (IABP) was inserted more frequently in the LMD group preoperatively (p=0.004). There were two conversions to on-pump during OPCAB surgery. There were no differences in the postoperative outcomes in the LMD group A versus group B, such as cardiac-related events, neurological deficits, cardiac enzyme course, arrhythmias, blood loss, infections and renal failure.
  
  
  CONCLUSIONS
  The presence of LMD and higher EuroSCORE does not yield adverse outcomes in OPCAB patients.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore.
authors.forename: George Naveen
authors.initials: GN
authors.lastname: Thomas
authors.forename: Eliana Cecilia
authors.initials: EC
authors.lastname: Martinez
authors.forename: Felix
authors.initials: F
authors.lastname: Woitek
authors.forename: Maximilian Y
authors.initials: MY
authors.lastname: Emmert
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: Sonja
authors.initials: S
authors.lastname: Muecke
authors.forename: Chuen Neng
authors.initials: CN
authors.lastname: Lee
authors.forename: Theo
authors.initials: T
authors.lastname: Kofidis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome