Off-pump coronary artery bypass
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Objectives: Off-pump coronary artery bypass grafting (CABG) on the beating heart has become popular procedure in cardiac surgery and its initial results appeared favorable. We report our early and mid-term results of off-pump CABG performed at Shin-Tokyo Hospital.Methods: Medical records of patients under-going off-pump or conventional on-pump CABG from September 1, 1996, to August 31, 1999 were retro-spectively reviewed. Patients underwent off-pump CABG were further classified into 2 groups; MIDCAB (Off-pump CABG for single vessel revascularization via a small skin incision) and OPCAB (off-pump CABG mainly approached via midline sternotomy) group. Their preoperative, perioperative, and follow-up data were collected and analyzed.Results: Among a total of 995 cases of CABG, 194 cases were off-pump CABG (male/female 142/52, mean age 66.9). The mean number of distal anastomoses in off-pump CABG was 1.9±0.9 (1.0±0.0 in MIDCAB and 2.3±0.7 in OPCAB), which was significantly fewer than in on-pump CABG (3.6±1.1), with p<0.0001. Intubation time (5.3±5.7) hours in off-pump CABG vs 13.1±24.2 hours in on-pump CABG), ICU stay (1.7±1.1 vs 3.2±3.0 days), and postoperative hospital stay (14.0±7.9 vs 18.1±12.1 days) in off-pump CABG were significantly shorter than in on-pump CABG (p<0.0001). In the off-pump CABG group, there were no in-hospital deaths and 14 major complications, fewer than in on-pump CABG (8 hospital deaths and 114 major complications). Postoperative angiography before hospital discharge was conducted in 80 patients (41.2%) and showed 2 occlusions, giving a graft patency rate of 98.6% in the off-pump group. During follow-up (0.9±0.6 year) period, there were 5 non-cardiac deaths and 20 cardiac events in the off-pump group. The actuarial survival rate at 36 months was 94.6% for off-pump CABG, showing no significant difference from the rate for conventional CABG patients (95.2% at 36 month, p=NS) The event-free rate was 84.0% at 36 months in off-pump CABG patients; however, which was less favorable than on-pump CABG patients (88.0% at 36 months, p<0.05).Conclusions: Both in-hospital and mid-term results for off-pump CABG patients were acceptable. Isolated CABG can thus be safely performed without cardiopulmonary bypass. Advances in coronary stabilization have contributed to these improved results. The observed long-term cardiac events may be related to incomplete revascularization.
Key wordscoronary artery bypass minimally invasive surgery off-pump bypass
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