title: High volume practice proved the safety of off-pump coronary artery bypass surgery in left main coronary artery lesions: a two-year single center experience.
abstract: BACKGROUND
  Left main coronary artery (LMCA) stenosis has been recognized as a risk factor for early death among patients undergoing coronary artery bypass grafting (CABG). This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass grafting (OPCABG), compared with non-left main coronary artery stenosis (non-mainstem disease).
  
  
  METHODS
  From January 1, 2009 to December 31, 2010, 4869 patients had a primary isolated OPCABG procedure at Beijing Anzhen Hospital. According to the pathology of LMCA lesions, they were retrospectively classified as a non-mainstem disease group (n = 3933) or a LMCA group (n = 936). Propensity scores were used to match the two groups, patients from the non-mainstem disease group (n = 831) were also randomly selected to match patients from the LMCA group (n = 831). Freedom from MACCE in the two groups was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  The difference in the mortality and the rate of MACCE during the first 30 days between the non-mainstem disease group and the LMCA group did not reach statistical significance (P = 0.429, P = 0.127 respectively). With a mean follow-up of (12.8 ± 7.5) months and a cumulative follow-up of 1769.6 patient-years, the difference in the freedom from MACCEs between the two groups, calculated through Kaplan-Meier method, did not reach statistical significance (P = 0.831).
  
  
  CONCLUSIONS
  Analysis of a high volume of OPCABG procedures proved that LMCA lesions do not pose additional early and mid-term risk to OPCABG. Therefore, a LMCA lesion is as safe as non-mainstem disease lesion during the OPCABG procedure.
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Liu
authors.forename: Jia-Kai
authors.initials: JK
authors.lastname: Lu
authors.forename: Hui-Li
authors.initials: HL
authors.lastname: Gan
authors.forename: Jian-Qun
authors.initials: JQ
authors.lastname: Zhang
authors.forename: Fang-Jong
authors.initials: FJ
authors.lastname: Huang
authors.forename: Cheng-Xiong
authors.initials: CX
authors.lastname: Gu
authors.forename: Qing-Yu
authors.initials: QY
authors.lastname: Kong
authors.forename: Xiang-Rong
authors.initials: XR
authors.lastname: Cao
authors.forename: Ping
authors.initials: P
authors.lastname: Bo
authors.forename: Chun-Shan
authors.initials: CS
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies