TY - JOUR
T1 - Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization
T2 - A prospective randomized study
AU - Muneretto, Claudio
AU - Bisleri, Gianluigi
AU - Negri, Alberto
AU - Manfredi, Jacopo
AU - Metra, Marco
AU - Nodari, Savina
AU - Dei Cas, Livio
AU - Bradley, Scott M.
AU - Sundt, Thoralf
AU - Arom, Kit
AU - Calhoon, John H.
PY - 2003/9/1
Y1 - 2003/9/1
N2 - Background. We investigated whether off-pump coronary artery bypass (OPCAB) surgery should be the procedure of choice in total arterial myocardial revascularization with composite grafts. Methods. We prospectively enrolled 176 patients undergoing total arterial myocardial revascularization and assigned them at random to one of two groups: group 1 was composed of 88 patients undergoing coronary surgery with cardiopulmonary bypass (CPB); group 2 consisted of 88 patients receiving the OPCAB procedure. We excluded from this study patients with significant risk factors for CPB-related morbidity. Composite arterial grafts in Y-T shape were realized in three different configurations according to patients' characteristics, coronary anatomy, and target stenosis. Results. There were no significant differences between the two groups in terms of preoperative characteristics and risk factors (Euroscore: group 1 = 6.1 ± 3.5, group 2 = 6.6 ± 3.8). Mean number of anastomoses was similar in both groups (group 1 = 2.8 ± 0.8, group 2 = 2.7 ± 0.5) whereas mean mechanical ventilation time (group 1 = 23 ± 9 hours, group 2 = 9 ± 4 hours), intensive care unit stay (group 1 = 43 ± 6 hours, group 2 = 22 ± 8 hours), and postoperative stay (group 1 = 7 ± 3 days, group 2 = 5 ± 2 days) were significantly reduced in group 2. Early mortality was 2.3% in group 1 and 3.4% in group 2 (p = not significant). Major postoperative complications occurred similarly in the two groups (atrial fibrillation: group 1 = 35.2%, group 2 = 21.6%; myocardial infarction: group 1 = 2.2%, group 2 = 1.1%; stroke: group 1 = 2.2%, group 2 = 0%; abdominal infarction: group 1 = 3.4%, group 2 = 0%). At follow-up (mean, 15 ± 12 months) no significant differences were observed in terms of survival free of any cardiac-related event (group 1 = 94.3%, group 2 = 96.5%; p = not significant). Conclusions. Off-pump coronary artery surgery could be successfully used for total arterial grafting without compromising the completeness of revascularization. Avoidance of CPB significantly decreased mechanical ventilation support and length of intensive care unit and postoperative stay; however in the absence of risk factors for cardiopulmonary bypass, off-pump coronary artery surgery did not improve early and midterm clinical outcome.
AB - Background. We investigated whether off-pump coronary artery bypass (OPCAB) surgery should be the procedure of choice in total arterial myocardial revascularization with composite grafts. Methods. We prospectively enrolled 176 patients undergoing total arterial myocardial revascularization and assigned them at random to one of two groups: group 1 was composed of 88 patients undergoing coronary surgery with cardiopulmonary bypass (CPB); group 2 consisted of 88 patients receiving the OPCAB procedure. We excluded from this study patients with significant risk factors for CPB-related morbidity. Composite arterial grafts in Y-T shape were realized in three different configurations according to patients' characteristics, coronary anatomy, and target stenosis. Results. There were no significant differences between the two groups in terms of preoperative characteristics and risk factors (Euroscore: group 1 = 6.1 ± 3.5, group 2 = 6.6 ± 3.8). Mean number of anastomoses was similar in both groups (group 1 = 2.8 ± 0.8, group 2 = 2.7 ± 0.5) whereas mean mechanical ventilation time (group 1 = 23 ± 9 hours, group 2 = 9 ± 4 hours), intensive care unit stay (group 1 = 43 ± 6 hours, group 2 = 22 ± 8 hours), and postoperative stay (group 1 = 7 ± 3 days, group 2 = 5 ± 2 days) were significantly reduced in group 2. Early mortality was 2.3% in group 1 and 3.4% in group 2 (p = not significant). Major postoperative complications occurred similarly in the two groups (atrial fibrillation: group 1 = 35.2%, group 2 = 21.6%; myocardial infarction: group 1 = 2.2%, group 2 = 1.1%; stroke: group 1 = 2.2%, group 2 = 0%; abdominal infarction: group 1 = 3.4%, group 2 = 0%). At follow-up (mean, 15 ± 12 months) no significant differences were observed in terms of survival free of any cardiac-related event (group 1 = 94.3%, group 2 = 96.5%; p = not significant). Conclusions. Off-pump coronary artery surgery could be successfully used for total arterial grafting without compromising the completeness of revascularization. Avoidance of CPB significantly decreased mechanical ventilation support and length of intensive care unit and postoperative stay; however in the absence of risk factors for cardiopulmonary bypass, off-pump coronary artery surgery did not improve early and midterm clinical outcome.
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U2 - 10.1016/S0003-4975(03)00564-2
DO - 10.1016/S0003-4975(03)00564-2
M3 - Article
C2 - 12963199
AN - SCOPUS:0042331672
SN - 0003-4975
VL - 76
SP - 778
EP - 783
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -