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Updated: Aug 22, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
[Off-pump myocardial revascularization in patients with multivessel coronary disease]
Giovanni Troise1, Federico Brunelli, Marco Cirillo
1Unità Funzionale di Cardiochirurgia, Ospedale Poliambulanza, Brescia. cch-segreteria.poli@poliambulanza.it
Insights
Off-pump coronary artery bypass grafting (CABG) is feasible for multivessel coronary disease, achieving complete revascularization. This technique demonstrates favorable early and intermediate-term outcomes, including low mortality and complication rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Context:
- Criticisms regarding completeness of revascularization in off-pump coronary artery bypass grafting (CABG) persist.
- Multivessel coronary artery disease (CAD) presents challenges for complete myocardial revascularization.
- The study evaluates the efficacy of off-pump CABG in a large cohort of patients with multivessel CAD.
Purpose:
- To assess the feasibility and outcomes of off-pump CABG in patients with multivessel coronary artery disease.
- To evaluate the completeness of revascularization achieved with the off-pump technique.
- To report early and intermediate-term clinical results, including mortality, morbidity, and survival rates.
Summary:
- 868 patients with multivessel CAD underwent off-pump CABG between 1997 and 2003, with >90% conversion to off-pump by 2000.
- An average of 2.5 anastomoses were performed per patient, with 55.2% achieving total arterial revascularization.
- In-hospital mortality was 0.6%, with a 3.5% incidence of major non-fatal complications. Survival rates at 1, 3, and 5 years were 97.3%, 93.7%, and 86.7%, respectively.
Impact:
- Demonstrates the feasibility of achieving complete myocardial revascularization using off-pump CABG in patients with multivessel CAD.
- Provides evidence of favorable early and intermediate-term clinical outcomes, supporting the safety and efficacy of the technique.
- Contributes to the body of evidence for off-pump CABG as a viable alternative to conventional on-pump procedures for complex coronary artery disease.
Background:
Some criticisms have been addressed to off-pump coronary surgery technique concerning the possibility of its systematic use with the respect of the completeness of revascularization. We report our experience with off-pump revascularization in patients with multivessel coronary disease.
Methods:
Between September 1997 and April 2003, 868 patients with multivessel coronary disease were scheduled for off-pump surgical revascularization. From September 2000, the percentage of patients operated on without cardiopulmonary bypass has been stably > 90%. Fifteen patients (1.7%) had a conversion to cardiopulmonary bypass for anatomical reasons (n = 6) or clinical instability (n = 9).
Results:
An average of 2.5 +/- 0.8 (range 1-5) anastomoses per patient were completed. Bilateral mammary artery was used in 573 patients (66%); totally arterial revascularization was accomplished in 479 patients (55.2%). In-hospital mortality rate was 0.6% (5 patients). Total incidence of non-fatal postoperative complications (bleeding requiring re-exploration, perioperative myocardial infarction, stroke, new onset of acute renal failure) was 3.5%. Mean postoperative hospital stay was 4.8 +/- 3.8 days. At a mean follow-up of 21.6 +/- 15.6 months (range 1-65 months), the postoperative actuarial survival rates were 97.3, 93.7 and 86.7% at 1, 3 and 5 years postoperatively. Actuarial freedom rates from new revascularization were 98.7, 96.6 and 96.6% at 1, 3 and 5 years postoperatively.
Conclusions:
Early- and intermediate-term results of this study demonstrate the feasibility of off-pump revascularization in all patients with multivessel coronary disease, respecting the criterion of complete myocardial revascularization.
