title: Comparison of off-pump and on-pump coronary endarterectomy for patients with diffusely diseased coronary arteries: early and midterm outcome.
abstract: BACKGROUND
  Coronary endarterectomy (CE) is an alternative for the diffusely diseased left anterior descending (LAD), but its mid and long term results are largely questionable. This study is to compare the early to mid-term results between off-pump and on-pump coronary endarterectomy with coronary artery bypass grafting.
  
  
  METHODS
  212 consecutive patients underwent CE and bypass grafting for diffusely diseased LAD. Ninety-two patients undergoing CE with off-pump (group off-pump) were compared with 120 patients undergoing CE with on-pump (group on-pump). The main preference for selection to an off-pump CE surgery were the preoperative high risk factors, especially previous cerebrovascular accident、chronic obstructive pulmonary disease (COPD)、calcified ascending aorta and right coronary artery (RCA) critical stenosis >90%.
  
  
  RESULTS
  There were three deaths in this group with total operative mortality of 1.4%. The perioperative mortality of group off-pump (1.1%) was similar with that of group on-pump (1.7%). The postoperative myocardial infarctions rate was 2.8%. There was no significant difference as for the morbidity between the group off-pump and group on-pump. Among survivors, the patency rate of the LIMA-LAD anastomosis was 89.4%. There was no difference as for the grafts patency rate between the two groups. Kaplan-Meier survival revealed no significant difference between the two groups. Kaplan-Meier freedom from cardiac events requiring hospital re-admission and angina recurrence were similar in both groups.
  
  
  CONCLUSIONS
  On-pump or off-pump CE is a good technique with the same early and mid-term outcomes. In the series of off-pump CE, we have shown that the effect of OPCABG with CE appears to be durable, and mid-term clinical outcomes are encouraging. Despite the higher risk profile, hospital mortality and major complications in our study are comparable to those for CCE.
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China. qiuzhibing2009@163.com.
authors.forename: Zhibing
authors.initials: Z
authors.lastname: Qiu
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China. stevecx1@163.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China. jiangyinsuo@sina.com.
authors.forename: YingShou
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China. wlm1971@yahoo.com.cn.
authors.forename: LiMing
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China. xuming2008@163.com.
authors.forename: Ming
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China. hfhdoctor@163.com.
authors.forename: Fuhua
authors.initials: F
authors.lastname: Huang
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China. shwdoctor@yahoo.com.cn.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China. ZhangcuiICU@163.com.
authors.forename: Cui
authors.initials: C
authors.lastname: Zhang
mesh_terms: D000368:Aged; D002681:China; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D023921:Coronary Stenosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012720:Severity of Illness Index; D016896:Treatment Outcome