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Ann Thorac Surg 2006;81:1691-1696
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Early and Late Outcome After Off-Pump Coronary Artery Bypass Graft Surgery With Coronary Endarterectomy: A Single-Center 10-Year Experience

Hunaid A. Vohra, MD, Raj Kanwar, MRCS, Tanveer Khan, FRCS, Wade R. Dimitri, FRCS *

Department of Cardiothoracic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry, United Kingdom

Accepted for publication December 7, 2005.

* Address correspondence to Dr Dimitri, Department of Cardiothoracic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry, United Kingdom (Email: wade.dimitri{at}uhcw.nhs.uk).

BACKGROUND: We aimed to review the early and late results of off-pump coronary artery bypass graft surgery (OPCABG) with coronary endarterectomy in patients undergoing surgical revascularization at our institution.

METHODS: Between 1995 and 2004, of 680 OPCABG patients in a single surgeon's practice (W.R.D.), 70 patients (10.29%) who underwent concomitant coronary endarterectomy were studied. The mean age was 63.6 ± 9.29 years. Thirty-three patients (55%) were Canadian Cardiovascular Society class III or IV, and 24 patients (40%) were New York Heart Association class III or IV. Eighteen patients (35%) had impaired left ventricular function. The mean EuroSCORE of these patients was 5.9 ± 1.8.

RESULTS: Fifty-seven patients (81%) underwent right coronary artery endarterectomy, and 12 patients (17%) underwent left anterior descending artery endarterectomy (8 left interior mammary arteries used as conduits). Four patients (5.7%) had two vessels endarterectomized. The mean number of grafts were 2.0 ± 0.4. The 30-day mortality rate was 2.85% (n = 2). Three patients (4.3%) suffered from postoperative myocardial infarction, and 3 patients (4.3%) required postoperative intra-aortic balloon pump counterpulsation. Mean intensive therapy unit stay was 17.6 ± 8.1 hours. Patients were extubated after a mean of 10.38 ± 4.9 hours. The mean length of hospital stay was 6.1 ± 2.0 days. Fourteen patients (20%) had postoperative atrial fibrillation, and only 1 patient (1.42%) had a transient stroke with complete recovery. There were no conversions to cardiopulmonary bypass. A mean of 0.86 ± 0.17 units of blood were transfused postoperatively. There was one reopening for bleeding, and 1 patient had renal failure requiring hemofiltration. The median follow-up was 4.91 years, 90% of patients were angina free, and the actuarial survival at 10 years was 78.04% ± 7.6%.

CONCLUSIONS: Off-pump coronary artery bypass graft survery with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse coronary artery disease.






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