Comparison of Off-Pump and Conventional Coronary Endarterectomy
DOI:
https://doi.org/10.1532/hsf.550Abstract
Objective: This study was designed to compare the early and midterm results of off-pump coronary endarterectomy (OPCE) with those of conventional coronary endarterectomy (CCE) performed with cardiopulmonary bypass.
Methods: From April 1, 1999, until March 1, 2001, 332 patients underwent off-pump coronary artery bypass grafting at our institution. From this total, 44 (13%) of the patients underwent supplementary OPCE (group 1). The results were compared with those for a group of age-, sex-, and risk factor-matched patients undergoing CCE (group 2) at the same institution. The mean follow-up period was 16 months. The indications for operation in group 1 were angina in 16 (36%) of the cases, cardiac failure in 20 (45%), and prognosis in 8 (19%). In group 2 angina was the indication for operation in 11 (25%) of the cases, cardiac failure in 5 (11%), and prognosis in 30 (64%) of the cases.
Results: In group 1, 35 patients underwent single and 9 underwent double endarterectomy. The procedures included 32 right coronary artery, 12 left anterior descending artery, 2 lateral circumflex artery, and 7 diagonal branch operations. Three (6.8%) of the patients in group 1 and 2 (4.4%) of the patients in group 2 developed postoperative myocardial infarction (P < .05). One (2.2%) of the patients in group 1 and 2 (4.4%) of the patients in group 2 died in the postoperative period (P < .05). The numbers of patients with perioperative neurologic deficit in groups 1 and 2 were 0 and 7, respectively (P < .001). Although the rate of perioperative myocardial infarction was higher in group 1, mortality, occurrence of other morbid events, intubation time, intensive care stay, and hospital length of stay were less in group 1 than group 2.
Conclusion: OPCE can be performed safely with morbidity and mortality comparable with those of CCE.
References
CASS Investigators. 1983. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery: survival data. Circulation 68:939-50.nChang Y, Shih CT, Lai ST. 1991. Early results of the advanced coronary endarterectomy combined with CABG in the treatment of coronary artery occlusive disease. Ann Thorac Surg 52:1187-9.nDagenais F, Cartier R, Farinas JM, Leclerc Y, Hudon G. 1998. Coronary endarterectomy revisited: mid-term angiographic results. Can J Cardioln14:1121-5.nDjalilian AR, Shumway SJ. 1995. Adjunctive coronary endarterectomy: improved safety in modern cardiac surgery. Ann Thorac Surg 60:1749-54.nFerraris VA, Harrah JD, Moritz DM, Striz M, Striz D, Ferraris SP. 2000. Long-term angiographic results of coronary endarterectomy. Ann Thorac Surg 69:1737-43.nBailey CP, May A, Lemmon WM. 1957. Survival after coronary endarterectomy in man. JAMA 164:641-6.nBedi HS, Kalkan MS. 2000. Endarterectomy on a beating heart [letter]. Ann Thorac Surg 70:338-9.nBenetti FJ. 1985. Direct coronary artery surgery with saphenous vein without either cardiopulmonary bypass or cardiac arrest. J Cardiovasc Surg 26:217-22.n
