title: Which is first: left anterior descending artery anastomosis or right coronary artery anastomosis in off-pump coronary artery bypass grafting?
abstract: OBJECTIVE
  The sequence of the distal anastomosis for revascularization in off-pump coronary artery bypass grafting (OPCABG) surgery is under debate. The hypothesis in this study was that an analysis of cardiac markers would reveal that anastomosing the left anterior descending coronary artery (LAD) before the right coronary artery (RCA) would decrease myocardial damage in OPCABG surgery for 2-vessel disease.
  
  
  METHODS
  Forty patients with stable angina who underwent OPCABG surgery and who had LAD and RCA lesions were randomized into 2 groups of 20 patients each. The LAD was revascularized first in group 1, and the RCA was revascularized first in group 2. Cardiac troponin I, creatine kinase (CK), and CK myocardial band (CK-MB) were measured in the 2 groups before surgery and at 8, 24, and 48 hours after surgery.
  
  
  RESULTS
  No mortality occurred in the 2 groups. The groups were similar with respect to sex, age, durations of anastomosis of the left internal thoracic artery to the LAD and of the saphenous vein graft to the RCA, and preoperative CK, CK-MB, and troponin I levels. Postoperative CK-MB levels were significantly higher in group 2 in the eighth and 24th postoperative hours than in group 1 (P = .009 and .041, respectively). Similarly, troponin I levels were significantly higher in group 2 in the eighth, 24th, and 48th hours than in group 1 (P = .003, .003, and .006, respectively).
  
  
  CONCLUSIONS
  Anastomosis to the LAD first in OPCABG surgery led to a slight reduction in myocardial enzyme release against the occlusion of the target vessels during anastomoses in patients with RCA and LAD stenoses.
authors.affiliation: Department of Cardiovascular Surgery, Gazi Hospital, Izmir.
authors.forename: Necmettin
authors.initials: N
authors.lastname: Yakut
authors.forename: Engin
authors.initials: E
authors.lastname: Tulukoğlu
authors.forename: Bilgin
authors.initials: B
authors.lastname: Emrecan
authors.forename: Serdar
authors.initials: S
authors.lastname: Bayrak
authors.forename: Levent
authors.initials: L
authors.lastname: Yilik
authors.forename: Tayfun
authors.initials: T
authors.lastname: Göktoğan
authors.forename: Ali
authors.initials: A
authors.lastname: Gürbüz
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D000787:Angina Pectoris / Q000601:surgery*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000201:enzymology; D011183:Postoperative Complications / Q000175:diagnosis / Q000201:enzymology; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood; D014680:Veins / Q000637:transplantation
chemical_list: D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form