Left main coronary artery disease does not affect the outcome of off-pump coronary artery bypass grafting.
BACKGROUND
Left main coronary artery (LMCA) stenosis (≥50%) has historically been recognized as a risk factor among patients undergoing coronary artery bypass grafting.


METHODS
From January 2002 to December 2008, a total of 665 patients, 268 of whom had significant LMCA disease, underwent isolated off-pump coronary artery bypass surgery at Shiga Medical University Hospital. We compared the clinical results in the 237 patients with LMCA stenosis (LMCA group) with those in the propensity score-matched 237 patients without LMCA stenosis (non-LMCA group). We performed off-pump surgery in all coronary artery bypass grafting cases with no exclusion criteria.


RESULTS
All procedures were performed by off-pump technique without conversion to on-pump. Two patients in the LMCA group (2 of 237; 0.8%) and four in the non-LMCA group (4 of 237; 1.7%) died within 30 days after surgery. Follow-up was completed in 96.2% of the patients. The rates of six-year freedom from all cause death were 87.3% and 60.7% in the LMCA group and non-LMCA group, respectively (p = 0.17), and the corresponding rates for the combined endpoint of cardiac death, myocardial infarction, angina pectoris, repeat coronary intervention, and heart failure were 80.4% and 70.4% (p = 0.98). Multivariate Cox regression analysis revealed chronic renal failure as a statistically significant predictor for late cardiac event.


CONCLUSIONS
Off-pump coronary artery bypass grafting is feasible and safe in patients with critical LMCA stenosis and LMCA disease is not recognized as a risk factor after off-pump coronary artery bypass grafting in either the short or the long term.
Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu City, Shiga, Japan. suzukit@belle.shiga-med.ac.jp
Tomoaki
T
Suzuki
Tohru
T
Asai
Keiji
K
Matsubayashi
Atsushi
A
Kambara
Norihiko
N
Hiramatsu
Takeshi
T
Kinoshita
Osamu
O
Nishimura
D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000150:complications*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome