Korean J Thorac Cardiovasc Surg.  2008 Feb;41(1):34-40.

Clinical Outcomes of Off-pump Coronary Artery Bypass Grafting

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Korea. jkshin@uuh.ulsan.kr
  • 2Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Korea.

Abstract

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) shows fewer side effects than cardiopulmonary bypass, and other benefits include myocardial protection, pulmonary and renal protection, coagulation, inflammation, and cognitive function. We analyzed the clinical results of our cases of OPCAB. MATERIAL AND METHOD: From May 1999 to August 2007, OPCAB was performed in 100 patients out of a total of 310 coronary artery bypass surgeries. There were 63 males and 37 females, from 29 to 82 years old, with a mean age of 62+/-10 years. The preoperative diagnoses were unstable angina in 77 cases, stable angina in 16, and acute myocardial infarction in 7. The associated diseases were hypertension in 48 cases, diabetes in 42, chronic renal failure in 10, carotid artery disease in 6, and chronic obstructive pulmonary disease in 5. The preoperative cardiac ejection fraction ranged from 26% to 74% (mean 56.7+/-11.6%). Preoperative angiograms showed three-vessel disease in 47 cases, two-vessel disease in 25, one-vessel disease in 24, and left main disease in 23. The internal thoracic artery was harvested by the pedicled technique through a median sternotomy in 97 cases. The radial artery and greater saphenous vein were harvested in 70 and 45 cases, respectively (endoscopic harvest in 53 and 41 cases, respectively). RESULT: The mean number of grafts was 2.7+/-1.2 per patient, with grafts sourced from the unilateral internal thoracic artery in 95 (95%) cases, the radial artery in 62, the greater saphenous vein in 39, and the bilateral internal thoracic artery in 2. Sequential anastomoses were performed in 46 cases. The anastomosed vessels were the left anterior descending artery in 97 cases, the obtuse marginal branch in 63, the diagonal branch in 53, the right coronary artery in 30, the intermediate branch in 11, the posterior descending artery in 9 and the posterior lateral branch in 3. The conversion to cardiopulmonary bypass occurred in 4 cases. Graft patency was checked before discharge by coronary angiography or multi-slice coronary CT angiography in 72 cases, with a patency rate of 92.9% (184/198). There was one case of mortality due to sepsis. Postoperative arrhythmias or myocardial infarctions were not observed. Postoperative complications were a cerebral stroke in 1 case and wound infection in 1. The mean time of respirator care was 20+/-35 hours and the mean duration of stay in the intensive care unit was 68+/-47 hours. The mean amounts of blood transfusion were 4.0+/-2.6 packs/patient.
CONCLUSION
We found good clinical outcomes after OPCAB, and suggest that OPCAB could be used to expand the use of coronary artery bypass grafting.

Keyword

Coronary artery bypass grafting; Off-pump

MeSH Terms

Angina, Stable
Angina, Unstable
Angiography
Arrhythmias, Cardiac
Arteries
Blood Transfusion
Cardiopulmonary Bypass
Carotid Artery Diseases
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Coronary Vessels
Female
Humans
Hypertension
Inflammation
Intensive Care Units
Kidney Failure, Chronic
Male
Mammary Arteries
Myocardial Infarction
Postoperative Complications
Pulmonary Disease, Chronic Obstructive
Radial Artery
Saphenous Vein
Sepsis
Sternotomy
Stroke
Transplants
Ventilators, Mechanical
Wound Infection
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