Off-Pump Innominate-Coronary Artery Bypass in Patients with Severely Atherosclerotic Ascending Aorta

Abstract

Background: Traditional aorto-coronary artery bypass surgery in patients with severely atherosclerotic ascending aorta is associated with unacceptable risk of neurologic injury. Recent advancement in off-pump coronary bypass technique eliminates the use of cardiopulmonary bypass as a cause of thromboembolism in patients with severely diseased aorta. The use of off-pump technique in conjunction with the use of the great vessels rather than the diseased ascending aorta as the inflow for the saphenous vein bypass grafts would theoretically eliminates any risk of thromboembolic neurologic injury.
Methods: This study consists of ten consecutive patients with severely diseased ascending aorta, who underwent off-pump saphenous vein bypasses from the innominate artery to various coronary targets with or without the use of the inter-nal mammary artery.
Results: The average age of the patients was 81. All patients had left main coronary disease, and all were in unstable angi-na. Two patients were dialysis dependent. The average bypass grafts was 2.3. The operating time was less than 3 hours in all cases. All patients were extubated within 12 hours of surgery. There were no incidence of neurologic injury or evidence of other thromboembolic end organ damage. There was no perioperative myocardial infarction. The median postopera-tive hospital length of stay was 6 days. All patients were found to be doing well and free of angina at a median follow up of 5 months.
Conclusions: The approach of off-pump innominate-coronary bypass is an important adjunct in the management of patients with unworkable ascending aorta.