title: No-touch aorta off-pump coronary bypass operation: arteriovenous composite grafts may be used as a last resort.
abstract: BACKGROUND
  Off-pump coronary artery bypass (OPCAB) operations with bilateral internal thoracic artery (BITA) or left internal thoracic artery (LITA) and radial artery (RA) in a Y-graft configuration achieves adequate myocardial revascularization while avoiding manipulation of the ascending aorta. The purpose of our study was to determine if saphenous veins can be used as composite grafts with the LITA as a last resort.
  
  
  METHODS
  Multivessel OPCAB without aortic manipulation was performed in 564 patients between February 2002 and October 2010. Patients receiving a LITA-vein composite graft (n = 62) were older and had more emergency procedures, renal insufficiency, peripheral vascular disease and therefore a higher logistic EuroSCORE predicted risk of mortality (all p < 0.001) than did patients who underwent BITA and LITA-RA grafts.
  
  
  RESULTS
  Overall 30-day mortality was 1.1%: 6.5% in patients who received LITA-vein grafts and 0.5% in both total arterial groups (p = 0.001). Neurologic events occurred in 3.2%, 0.7%, and 0.5% of patients, respectively (p = 0.3). No patient who received a LITA-vein graft experienced perioperative myocardial infarction (MI). Patients in the total arterial graft groups had better 5-year survival (> 90%) and freedom from major adverse cardiovascular and cerebrovascular events (≥ 80%) than did patients who received LITA-vein grafts (74 ± 7.8% and 62.5 ± 8.1%, respectively). However there was no difference in the 3 groups with respect to freedom from MI and repeat revascularization.
  
  
  CONCLUSIONS
  LITA-vein composite graft use is associated with a lower survival and higher complication rate, probably because of the higher patient risk profile. LITA-vein composite grafts may be used as a last resort in selected patients undergoing OPCAB operations without manipulation of the aorta when arterial grafts are not available or recommended.
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. pirarm@hotmail.com
authors: Piroze M
authors: PM
authors: Davierwala
authors: Sergey
authors: S
authors: Leontyev
authors: Martin
authors: M
authors: Misfeld
authors: Ardawan
authors: A
authors: Rastan
authors: David
authors: D
authors: Holzhey
authors: Sven
authors: S
authors: Lehmann
authors: Michael A
authors: MA
authors: Borger
authors: Friedrich W
authors: FW
authors: Mohr
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D016896:Treatment Outcome