Ten-Year Outcome Analysis of Off-Pump Sequential Grafting: Single Surgeon, Single Center Experience


  • Shahzad G. Raja
  • Kareem Salhiyyah
  • Manoraj Navaratnarajah
  • Muhammad Umar Rafiq
  • Jeremy Felderhof
  • Christopher P. Walker
  • Charles D. Ilsley
  • Mohamed Amrani




Objectives: Despite increasing recognition that off-pump coronary artery bypass surgery and sequential grafting strategy individually are associated with improved outcomes, concerns persist regarding the safety and efficacy of combining these 2 techniques. We compared in-hospital and midterm outcomes for off-pump multivessel sequential and conventional coronary artery bypass grafting.

Methods: From September 1998 to September 2008, 689 consecutive patients received off-pump multivessel sequential coronary artery bypass grafting performed by a single surgeon. These patients were propensity matched to 689 patients who underwent off-pump coronary artery bypass grafting without sequential anastomoses. A retrospective analysis of prospectively collected perioperative data was performed. In addition, medical notes and charts of all the study patients were reviewed. The mean duration of follow-up was 5.1 ± 2.0 years.

Results: The major in-hospital clinical outcomes in the sequential and control groups were found to be similar. After adjusting for clinical covariates, sequential grafting was not an independent predictor of in-hospital adverse events (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.86-1.50; P = .31), medium-term mortality (hazard ratio [HR], 1.26; 95% CI, 1.06-1.32; P = .92), and readmission to hospital (HR, 1.12; 95% CI, 0.96-1.20; P = .80). Sequential grafting was an independent predictor of receiving more than 3 distal anastomoses (OR, 7.46; 95% CI, 4.27-11.45; P < .0001). Risk-adjusted survival was 89% for sequential grafting patients and 88% for conventional grafting patients (P = .96) during the medium-term follow-up.

Conclusion: Our analysis confirms the short- and midterm safety and efficacy of off-pump sequential coronary artery bypass grafting.


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How to Cite

Raja, S. G., Salhiyyah, K., Navaratnarajah, M., Rafiq, M. U., Felderhof, J., Walker, C. P., Ilsley, C. D., & Amrani, M. (2012). Ten-Year Outcome Analysis of Off-Pump Sequential Grafting: Single Surgeon, Single Center Experience. The Heart Surgery Forum, 15(3), E136-E142. https://doi.org/10.1532/HSF98.20111087




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