Ten-year outcome analysis of off-pump sequential grafting: single surgeon, single center experience.
OBJECTIVE
Despite increasing recognition that off-pump coronary artery bypass surgery and sequential grafting strategy individually are associated with improved outcomes, concerns persist regarding the safety and efficacy of combining these 2 techniques. We compared in-hospital and midterm outcomes for off-pump multivessel sequential and conventional coronary artery bypass grafting.


METHODS
From September 1998 to September 2008, 689 consecutive patients received off-pump multivessel sequential coronary artery bypass grafting performed by a single surgeon. These patients were propensity matched to 689 patients who underwent off-pump coronary artery bypass grafting without sequential anastomoses. A retrospective analysis of prospectively collected perioperative data was performed. In addition, medical notes and charts of all the study patients were reviewed. The mean duration of follow-up was 5.1 ± 2.0 years.


RESULTS
The major in-hospital clinical outcomes in the sequential and control groups were found to be similar. After adjusting for clinical covariates, sequential grafting was not an independent predictor of in-hospital adverse events (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.86-1.50; P = .31), medium-term mortality (hazard ratio [HR], 1.26; 95% CI, 1.06-1.32; P = .92), and readmission to hospital (HR, 1.12; 95% CI, 0.96-1.20; P = .80). Sequential grafting was an independent predictor of receiving more than 3 distal anastomoses (OR, 7.46; 95% CI, 4.27-11.45; P < .0001). Risk-adjusted survival was 89% for sequential grafting patients and 88% for conventional grafting patients (P = .96) during the medium-term follow-up.


CONCLUSIONS
Our analysis confirms the short- and midterm safety and efficacy of off-pump sequential coronary artery bypass grafting.
Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom. drrajashahzad@hotmail.com
Shahzad G
SG
Raja
Kareem
K
Salhiyyah
Manoraj
M
Navaratnarajah
Muhammad Umar
MU
Rafiq
Jeremy
J
Felderhof
Christopher P
CP
Walker
Charles D
CD
Ilsley
Mohamed
M
Amrani
D000368:Aged; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology