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

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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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