Off-pump versus on-pump coronary artery bypass surgery for the treatment of left main with triple coronary artery disease⋆

ObjectiveTo obtain early results of off-pump coronary artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB).MethodsData for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demographic and preoperative risk factors, operative details, clinical outcome and early follow-up.ResultsThe number of distal anastomosis and grafts varied from 3 to 6. The average number per patient was similar in the two groups (OPCAB group:3.76 + 0.98, CCAB group:3.81 + 1.02). Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance (P > 0.05). The frequency of atrial fibrillation (AF), IABP usage, mediastinitis, re-operation for bleeding (or tamponade) were similar in the two groups (P > 0.05). Postoperative inotropic requirements, peak CK-MB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group(P< 0.05).ConclusionSignificant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.