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Off-pump total arterial revascularization: our experience
Rubén Fernández Tarrío1, José Joaquin Cuenca, Valdemar Gomes
1Cardiac Surgery Service, Juan Canalejo Hospital, A Coruña, Spain. rutarrio@yahoo.es
Insights
The Tector technique for off-pump coronary artery bypass grafting using both internal thoracic arteries is safe and effective. This approach reduces complications associated with traditional bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Off-pump coronary artery bypass grafting (CABG) offers an alternative to cardiopulmonary bypass.
- The Tector technique utilizes both internal thoracic arteries for CABG.
- Minimizing morbidity associated with extracorporeal circulation and aortic cross-clamping is a key goal in cardiac surgery.
Purpose of the Study:
- To evaluate the safety and efficacy of the Tector technique for off-pump CABG.
- To describe the surgical experience and outcomes of this specific CABG approach.
Main Methods:
- The Tector technique was performed on 743 patients between April 1998 and December 2003.
- Both internal thoracic arteries were harvested using skeletonization and anastomosed as "Y" or "T" grafts.
- Intraoperative graft patency was assessed using a Doppler flowmeter.
Main Results:
- A total of 2028 distal anastomoses were performed (average 2.7 per patient).
- Postoperative complications included atrial fibrillation (5.4%), myocardial infarction (3.2%), and stroke (0.4%).
- The early mortality rate was 3.2%.
Conclusions:
- The off-pump Tector technique demonstrates a favorable safety profile.
- This method shows low surgical morbidity in patients undergoing coronary artery bypass grafting.
Background And Aim:
Off-pump coronary artery bypass grafting with both the internal thoracic arteries, such as the Tector technique, can reduce the morbidity associated with extracorporeal circulation and aortic cross-clamp. The aim of the present study is to describe our experience and the results obtained.
Methods:
From April 1998 to December 2003, the off-pump Tector technique was performed on 743 patients, of whom 621 were male (83.5%), with a mean age of 65.3 +/- 9.5 years (23-90). Preoperative risk factors were diabetes mellitus in 29.5% and peripheral vasculopathy in 14.7% of the patients. Angiography showed left main disease in 25.6% and triple-vessel disease in 50.3% of the patients, with a mean ejection fraction of 60%+/- 13% (23-88). Both the internal thoracic arteries were harvested using the skeletonization technique and were anastomosed as "Y" or "T" grafts. Intraoperative graft patency was checked using a Doppler flowmeter.
Results:
A total of 2028 distal anastomoses were performed, the average being 2.7 (1 to 5) per patient. At least three distal anastomoses were undertaken in 62% of the patients. Postoperative complications included atrial fibrillation in 40 patients (5.4%), myocardial infarction in 24 (3.2%), mediastinitis and reoperation for bleeding in 7 (0.9%) and stroke in 3 (0.4%). Twenty-four patients (3.2%) died in the first month postoperatively.
Conclusions:
The off-pump Tector technique appears to be safe, showing a low surgical morbidity.
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