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Published on: September 15, 2023
Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass
S N Omeroğlu1, K Kirali, M Güler
1Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
Insights
Off-pump coronary artery bypass grafting (CABG) shows comparable midterm and long-term graft patency to conventional methods. Arterial grafts and those to the left anterior descending artery demonstrated superior patency rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Graft Patency Research
Background:
- Coronary artery bypass grafting (CABG) can be performed on a beating heart.
- Off-pump CABG is a viable alternative to conventional techniques.
- This study assesses long-term graft patency after off-pump CABG.
Purpose of the Study:
- To evaluate the midterm and long-term graft patency of off-pump coronary artery bypass grafting (CABG).
- To compare graft patency rates between arterial and venous conduits.
- To identify predictors of graft occlusion and assess impact on left ventricular function.
Main Methods:
- A cohort of 696 patients underwent off-pump CABG between September 1993 and December 1996.
- 70 randomly selected patients underwent angiographic assessment 24 to 61 months post-surgery.
- Multivariate analysis was used to identify predictors of graft occlusion.
Main Results:
- Left internal mammary artery to left anterior descending artery grafts had 95.59% patency.
- Vein graft patency was 47.06%.
- Graft patency was significantly higher for the left anterior descending artery (95.71%) compared to other coronary arteries (45.45%). Graft type and hyperlipidemia were significant predictors of occlusion. Left ventricular function improved post-surgery.
Conclusions:
- Off-pump CABG offers midterm and long-term graft patency comparable to conventional CABG.
- Arterial conduits, particularly to the left anterior descending artery, show excellent patency.
- Off-pump CABG is a safe and effective alternative for coronary revascularization.
Background:
Coronary bypass surgery that provides good long-term graft patency can be performed on the beating heart as a viable alternative to conventional coronary artery bypass grafting (CABG).
Methods:
From September 1993 to December 1996, 696 patients underwent CABG on the beating heart at the Koşuyolu Heart and Research Hospital in Istanbul. Among them, 70 patients were chosen randomly for angiographic assessment of off-pump coronary artery bypass grafting.
Results:
The interval from operation to angiography varied from 24 to 61 months (mean, 36.1+/-10.9 months). The patency rate of left internal mammary-left anterior descending artery anastomoses was 95.59% (patency achieved in 65 of 68 patients) and of vein grafts was 47.06% (patency achieved in 16 of 34 patients) (p < 0.0001). The patency rates of grafts anastomosed to the left anterior descending artery were significantly higher than the rates of the grafts anastomosed to the other coronary arteries (95.71% versus 45.45%, p < 0.0001). Multivariate analysis showed that graft type (p < 0.0001) and hyperlipidemia (p = 0.023) were significant predictors for graft occlusion. Left ventricular function improved significantly after CABG (p = 0.04). Reintervention (using percutaneous transluminal cardiac angioplasty) and reoperation rates were 0.97% and 1.4%, respectively.
Conclusions:
Off-pump coronary artery bypass grafting appears to produce midterm and long-term patency rates that are comparable to those of conventional techniques; that is especially true in cases of arterial conduits and of conduits anastomosed to the left anterior descending artery.
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