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Ann Thorac Surg 2000;70:844-849
© 2000 The Society of Thoracic Surgeons

Original articles: cardiovascular

Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass

Suat Nail Ömerolu, MDa, Kaan Kirali, MDa, Mustafa Güler, MDa, Mehmet Erdem Toker, MDa, Gökhan pek, MDa, Ömer Iik, MDa, Cevat Yakut, MDa

a Department of Cardiovascular Surgery, Kouyolu Heart and Research Hospital, Istanbul, Turkey

Address reprint requests to Dr Kirali, Kouyolu Kalp Eitim ve Aratirma Hastanesi, 81020 Kadiköy, Istanbul, Turkey
e-mail: kosuyolu{at}superonline.com

Background. Coronary bypass surgery that provides good long-term graft patency can be performed on the beating heart as a viable alternative to conventional coronary artery bypass grafting (CABG).

Methods. From September 1993 to December 1996, 696 patients underwent CABG on the beating heart at the Kouyolu Heart and Research Hospital in Istanbul. Among them, 70 patients were chosen randomly for angiographic assessment of off-pump coronary artery bypass grafting.

Results. The interval from operation to angiography varied from 24 to 61 months (mean, 36.1 ± 10.9 months). The patency rate of left internal mammary–left anterior descending artery anastomoses was 95.59% (patency achieved in 65 of 68 patients) and of vein grafts was 47.06% (patency achieved in 16 of 34 patients) (p < 0.0001). The patency rates of grafts anastomosed to the left anterior descending artery were significantly higher than the rates of the grafts anastomosed to the other coronary arteries (95.71% versus 45.45%, p < 0.0001). Multivariate analysis showed that graft type (p < 0.0001) and hyperlipidemia (p = 0.023) were significant predictors for graft occlusion. Left ventricular function improved significantly after CABG (p = 0.04). Reintervention (using percutaneous transluminal cardiac angioplasty) and reoperation rates were 0.97% and 1.4%, respectively.

Conclusions. Off-pump coronary artery bypass grafting appears to produce midterm and long-term patency rates that are comparable to those of conventional techniques; that is especially true in cases of arterial conduits and of conduits anastomosed to the left anterior descending artery.




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