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Ann Thorac Surg 2002;73:798-802
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Conversion to off-pump coronary bypass without increased morbidity or change in practice

^a Harefield Hospital, Uxbridge, United Kingdom

Accepted for publication October 15, 2001.

* Address reprint requests to Dr Amrani, Harefield Hospital, Uxbridge, Middlesex UB9 6JH, United Kingdom
e-mail: mr.amrani{at}rbh.nthames.nhs.uk

Background. This article examines the feasibility of complete conversion from conventional coronary artery operation to routine off-pump coronary bypass operation.

Methods. Data on our first 285 off-pump procedures using the Octopus system (Medtronic Inc, Minneapolis, MN) represent our learning curve. This is a complete experience in coronary bypass surgery over 16 months.

Results. The cohort was nonselected. All patients had at least two-vessel disease. Eight hundred seven grafts were performed (mean, 2.8 per patient) of which 647 grafts (84%) were arterial (mean, 2.3 per patient). One hundred seventy nine patients (63%) underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications were: mortality, 3 patients (1.5%); renal failure, 24 patients (8%); stroke, 2 patients (< 1%); and atrial fibrillation, 60 patients (21%). The morbidity data and frequency of arterial grafting did not differ from that of 355 patients who underwent coronary bypass operations in a preceding 18-month period.

Conclusions. Complete shift from routine use of cardiopulmonary bypass to nonselective off-pump coronary bypass operation is possible with a low conversion rate and without an apparent increase in morbidity or change in technique. Whereas short-term safety and efficacy seem certain, studies of long-term outcome are necessary before the eventual role of off-pump coronary bypass in myocardial revascularization can be defined.

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