Off-pump coronary artery bypass grafting for patients with left main disease
1Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan.
Insights
Off-pump coronary artery bypass grafting (CABG) shows favorable outcomes for left main disease patients. This surgical option offers a high survival rate and low event rate, supporting its use.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Multivessel off-pump coronary artery bypass grafting (CABG) has demonstrated positive results.
- Outcomes for off-pump CABG specifically in patients with left main disease require further clarification.
Purpose of the Study:
- To analyze the surgical outcomes of off-pump CABG in patients diagnosed with left main coronary artery disease.
- To evaluate the safety and efficacy of this approach for a complex patient group.
Main Methods:
- A retrospective analysis of 147 patients who underwent off-pump CABG for left main disease between March 1999 and July 2002.
- Data collected included perioperative details and follow-up information, with a mean follow-up of 2.1 years.
Main Results:
- The study involved 147 patients, with 86.4% achieving complete revascularization. The in-hospital mortality rate was low at 0.7%.
- Postoperative complications such as myocardial infarction and stroke were infrequent. The 3-year actuarial survival rate was 97.0%, with an event-free rate of 94.3%.
Conclusions:
- Off-pump CABG is a viable surgical strategy for patients with left main disease.
- The procedure is associated with favorable short-term and long-term outcomes, including high survival rates.
Background:
Multivessel off-pump coronary artery bypass grafting (CABG) has been performed with favorable results in our institute. In this study, we analyzed the outcomes in patients who underwent off-pump CABG for left main disease, since the surgical outcomes for such patients have not been clarified.
Methods:
Between March 1, 1999 and July 30, 2002, a total of 147 patients with left main disease (112 males and 35 females, mean age 66.9 +/- 9.8 years) underwent off-pump CABG. Perioperative and follow-up data were entered into a structured database and the results were analyzed.
Results:
Urgent or emergent surgery was performed in 25 patients (17.0%), and a preoperative intra-aortic balloon pump was used in 12 patients (8.2%). The mean number of bypass grafts was 3.2 +/- 1.0, and complete revascularization was performed in 127 patients (86.4%). There were 4 incidences of intraoperative conversion from off-pump to on-pump surgery. The mean intubation period, intensive care unit stay and postoperative hospital stay were 9.4 +/- 13.0 h, 2.3 +/- 1.4 days and 13.4 +/- 7.3 days, respectively. There was 1 hospital death (0.7%). Postoperative myocardial infarction was observed in 2 patients (1.4%), postoperative stroke in 1 (0.7%), prolonged ventilator support in 5 (3.4%) and mediastinitis in 3 (2.0%). During the follow-up period of 2.1 +/- 1.0 years, there were 4 deaths and 7 cardiac events. The actuarial 3-year survival rate was 97.0%, and the event-free rate was 94.3%.
Conclusion:
Our observations support off-pump CABG as a surgical option with a favorable outcome for patients with left main disease.
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