Individualized off-pump all internal thoracic artery revascularization.
OBJECTIVE
We developed an individualized off-pump approach in an all internal thoracic artery (AITA) composite graft revascularization (AITACR) program to minimize postoperative neurological complications and to obtain the best long-term results possible. Early results of the individualized approach are reported.


METHODS
The operative method (on-pump or off-pump) was determined based on institutional selection criteria. Early neurological outcomes were evaluated in 157 men and 42 women; the mean age was 67.3 +/- 9.3 years.


RESULTS
Fifty-nine underwent off-pump procedures and 140 on-pump. The off-pump patients were older than the on-pump patients. The prevalence of diabetes mellitus, history of previous cerebral infarction, and atherosclerotic disease in the ascending aorta was more frequent in the off-pump group than in the on-pump group. The total number of distal anastomoses was 3.2 +/- 0.9 per patient. There was no operative mortality. Three patients (1 in the off-pump group and 2 in the on-pump group) had postoperative cerebral infarctions possibly related to postoperative atrial fibrillation.


CONCLUSIONS
When patients were allocated to the on-pump group or the off-pump group based on our criteria, excellent results were achieved with acceptable morbidity. An individualized off-pump approach in an AITACR program appears reasonable and safe with excellent early neurological outcomes.
Izumoto
Hiroshi
H
Department of Cardiovascular Surgery, Akita University School of Medicine, Akita, Japan.
Oka
Takanori
T
Kawazoe
Kohei
K
Ishibashi
Kazuyuki
K
Yamamoto
Fumio
F
D000368:Aged; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging; D001027:Aortography / Q000379:methods; D001281:Atrial Fibrillation / Q000209:etiology; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000150:complications / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control; D018579:Patient Selection; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome