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Osamu Tagusari
Junjiro Kobayashi
Ko Bando
Kazuo Niwaya
Hiroyuki Nakajima
Takeshi Nakatani
Toshikatsu Yagihara
Soichiro Kitamura
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Right arrow Coronary disease

Ann Thorac Surg 2004;78:1304-1311
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Total Arterial Off-Pump Coronary Artery Bypass Grafting for Revascularization of the Total Coronary System: Clinical Outcome and Angiographic Evaluation

Osamu Tagusari, MDa,*, Junjiro Kobayashi, MDa, Ko Bando, MDa, Kazuo Niwaya, MDa, Hiroyuki Nakajima, MDa, Takeshi Nakatani, MDa, Toshikatsu Yagihara, MDa, Soichiro Kitamura, MDa

a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan

Accepted for publication March 30, 2004.

* Address reprint requests to Dr Tagusari, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
otagusar{at}hsp.ncvc.go.jp

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

BACKGROUND: We assessed the clinical outcome and conducted an angiographic study of total arterial off-pump coronary artery bypass grafting for revascularization of the total coronary system.

METHODS: Of 382 consecutive patients who underwent off-pump coronary artery bypass between April 2000 and December 2002, 235 patients (193 men and 42 women, mean age 66 ± 9 years) with three-vessel disease underwent off-pump coronary artery bypass with all arterial grafts. A total of 872 vessels were bypassed (average number of grafts 3.7 ± 0.8). The internal thoracic arteries, radial arteries, and gastroepiploic arteries were used for revascularization of 306, 542, and 24 coronary arteries, respectively. Two hundred twenty-five patients underwent revascularization with composite grafts that were connected to the in situ internal thoracic artery (Y configuration 181, I configuration 55, K configuration 27, X configuration 3, T configuration 1); 10 patients underwent revascularization with all in situ grafts.

RESULTS: Three (1.3%) hospital deaths and 1 late death occurred. There were no occurrences of clinical underperfusion syndrome or new intraaortic balloon pump insertion. Cerebral infarction occurred in 2 patients (0.8%). Early postoperative angiography was performed on 833 grafts in 223 patients (95%); the overall patency rate was 98%. Stratified by coronary distribution, the patency rate was 99% (218/221) in the left anterior descending artery, 97% (84/87) in the diagonal artery, 99% (70/71) in the obtuse marginal artery, 98% (262/268) in the posterolateral artery, 98% (167/170) in the posterior descending artery, and 100% (16/16) in the right coronary artery.

CONCLUSIONS: Total arterial off-pump coronary artery bypass yielded good clinical results and an excellent patency rate of revascularization for the total coronary system.




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