Total Arterial Revascularization for Multiple Vessel Coronary Artery Disease: With or without Cardiopulmonary Bypass

Authors

  • Marek A. Deja
  • Kazimierz Widenka
  • Piotr Duraj
  • Marek Jasinski
  • Ryszard Bachowski
  • Roman Mrozek
  • Radoslaw Gocol
  • Damian Hudziak
  • Krzysztof S. Golba
  • Jolanta Biernat
  • Stanislaw Wos

DOI:

https://doi.org/10.1532/HSF98.20041089

Abstract

Background: To assess the usefulness of off-pump technique for more technically demanding coronary artery bypass procedures using exclusively arterial conduits.

Methods: Analysis of perioperative data of 324 consecutive patients in whom total arterial revascularization for multiple-vessel coronary artery disease was performed--181 cases on-pump and 143 cases off-pump.

Results: On average in the on-pump group 2.7 ± 0.8 (range, 2-5) grafts per patient were constructed versus 2.4 ± 0.7 (range, 2-4) grafts per patient in the off-pump group (P < .001). Of the total number of 490 anastomoses performed on-pump, 83 (17%) were side-to-side and of 349 anastomoses performed off-pump, 51(15%) were side-to-side, a nonsignificant difference (P = .4). The aorta was used as a site for proximal anastomosis of 1 or more arterial conduits in 105 patients (58%) who underwent on-pump surgery and in 57 patients (40%) who underwent off-pump surgery (P = .002). In the off-pump group, the right internal thoracic artery (RITA) was rarely (12%) routed through the transverse sinus to circumflex branches compared with the on-pump group (34%) (P = .017). RITA in off-pump patients was more often used to revascularize the anterior wall (47% versus 29%; P = .08). We observed no difference in mortality (1.7% versus 0%; P = .3), incidence of perioperative myocardial infarction (8.8% versus 7.7%; P = .8), stroke (1.7% versus 1.4%; P = .8), or atrial fibrillation (24% versus 19%; P = .3). We observed less inotropic support and less blood-product use in off-pump patients.

Conclusion: Total arterial revascularization for multiple-vessel coronary artery disease may be safely performed off-pump. We observed tendency to somewhat smoother postoperative course in the off-pump group.

References

Ascione R, Williams S, Lloyd CT, et al. 2001. Reduced postoperative blood loss and transfusion requirement after beating heart coronary operations: a prospective randomized study. J Thorac Cardiovasc Surg 121:689.nBarner H, Barnett M. 1994. Fifteen- to twenty-one-year angiographic assessment of internal thoracic artery as a bypass conduit. Ann Thorac Surg 57:1526-8.nBuxton BF. 2003. Complete arterial grafting for coronary artery disease? J Thorac Cardiovasc Surg 125:782-3.nChavanon O, Carrier M, Cartier R, et al. 2001. Increased incidence of acute ascending aortic dissection with off-pump aortocoronary bypass surgery? Ann Thorac Surg 71:117-21.nDewey TM, Mack MJ. 2003. Myocardial revascularization without cardiopulmonary bypass. In: Cohn LH, Edmunds LH, editors. Cardiac surgery in the adult. New York: McGraw-Hill. p 609-25.nEdmunds LH, Hessel II EA, Colman RW, et al. 2003. Extracorporeal circulation. In: Cohn LH, Edmunds LH, editors. Cardiac surgery in the adult. New York: McGraw-Hill. p 315-87.nJones EL, Weintraub WS. 1996. The importance of completeness of revascularization during long-term follow-up after coronary artery operations. J Thorac Cardiovasc Surg 112:227-37.nKim KB, Lim C, Lee C, et al. 2001. Off-pump coronary artery bypass may decrease the patency of saphenous vein grafts. Ann Thorac Surg 72:1033-7.nLev-Ran O, Pevni D, Matsa M, et al. 2001. Arterial myocardial revascularization with in-situ crossover right internal thoracic artery to left anterior descending artery. Ann Thorac Surg 72:798-803.nLoop FD, Lytle BW, Cosgrove DM, et al. 1986. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1-6.nLytle BW, Blackstone EH, Loop FD, et al. 1999. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 117:855-72.nMueller XM, Chassot G, Zhou J. 2002. Hemodynamic optimization during off-pump coronary artery bypass: the "no compression" technique. Eur J Cardiothorac Surg 22:249-54.nMunaretto C, Negri A, Manfredi J, et al. 2003. Safety and usefulness of composite grafts for total arterial myocardial revascularization: a prospective randomized evaluation. J Thorac Cardiovasc Surg 125:826-35.nNgage DL. 2003. Off-pump coronary artery bypass grafting: the myth, the logic and the science. Eur J Cardiothorac Surg 24:557-70.nPuskas JD, Thourani VH, Marshall JJ, et al. 2001. Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Ann Thorac Surg 71:1477-84.nPuskas JD, Williams WH, Duke PG, et al. 2003. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:797-808.nQuigley RL, Weiss SJ, Highbloom RY, et al. 2001. Creative arterial grafting can be performed on the beating heart. Ann Thorac Surg 72:793-7.nTavilla G, Kappetein AP, Braun J, et al. 2004. Long-term follow-up of coronary artery bypass grafting in three-vessel disease using exclusively pedicled bilateral internal thoracic and right gastroepiploic arteries. Ann Thorac Surg 77:794-9.nUra M, Sakata R, Nakayama Y, et al. 1998. Long-term patency rate of right internal thoracic artery bypass via the transverse sinus. Circulation 98:2043-8.nVan Dijk D, Nierich AP, Jansen EWL, et al. 2001. Early outcome after off-pump versus on pump coronary bypass surgery. Circulation 104:1761-6.nYokoyama T, Baumgartner FJ, Gheissari A, et al. 2001. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg 72:1630.n

Published

2005-01-04

How to Cite

Deja, M. A., Widenka, K., Duraj, P., Jasinski, M., Bachowski, R., Mrozek, R., Gocol, R., Hudziak, D., Golba, K. S., Biernat, J., & Wos, S. (2005). Total Arterial Revascularization for Multiple Vessel Coronary Artery Disease: With or without Cardiopulmonary Bypass. The Heart Surgery Forum, 7(5), E493-E497. https://doi.org/10.1532/HSF98.20041089

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