Left main coronary disease: improved early outcomes after off-pump coronary artery bypass grafting in high-risk patients.
BACKGROUND
Left main coronary artery (LMCA) stenosis is a risk factor in coronary artery bypass grafting (CABG). Although improved outcomes of off-pump CABG have been well documented, LMCA stenosis is often perceived as a contraindicationfor off-pump CABG. In this study, we compared on-pump and off-pump techniques in high-risk patients with LMCA disease.


OBJECTIVE
Documentation of safety and feasibility of off-pump CABG in patients with LMCA disease.


METHODS
One hundred ninty nine patients with LMCA disease and a EuroScore ≥ 5 were operated upon between 2007 and 2010. One hundred patients (Group I) were operated upon using off-pump techniques, while 99 (Group II) were operated upon using conventional on-pump techniques. Perioperative variables and outcomes at first six months were compared.


RESULTS
Despite higher mean age and EuroScore (70.9 ± 4.8 vs. 65.6 ± 7.9, p < 0.001, and 6.09 ± 0.8 vs. 5.31 ± 0.68,p < 0.001, respectively), and lower ejection fraction (41.4 ± 7.3 vs. 49.0 ± 6.2, p < 0.001), hospital mortality (1% vs. 6.1%,p = 0.065), postoperative inotropic support (9% vs. 48.4%, p < 0.001), blood loss (680.6 ± 265.0 vs. 847.2 ± 382, p < 0.001) and transfusions of blood (0.57 ± 0.79 U vs. 1.49 ± 0.82 U, p < 0.001), and hospital stay (6.57 ± 2.04 vs. 7.68 ± 3.44,p = 0.006) were lower in Group I. In both groups, mean number of distal anastomoses and completeness of revascularisation were similar.


CONCLUSIONS
Using the off-pump technique is safe and improves postoperative early outcomes in high-risk patients with LMCA disease.
Diskapi Yildirim Beyazit E. A. Hospital. ukiziltepe@gmail.com.
Ugursay
U
Kiziltepe
Murat
M
Kurtoglu
Gokhan
G
Ozerdem
Sahin
S
Sahinalp
Zeki
Z
Temizturk
Muhammed
M
Bozguney
D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome