Off-pump bypass surgery: the early experience, 1969-1985

This is a review of 733 patients who underwent off-pump bypass surgery of the right coronary artery and left anterior descending coronary artery between 1969 and 1985. Two hundred sixty-four patients underwent single bypass of the left anterior descending coronary artery, and 79 patients underwent single bypass of the right coronary artery. Both the left anterior descending and right coronary arteries were bypassed in 390 patients. In contrast to the present-day use of mechanical devices to stabilize the target vessel, a 4-suture surgical technique was used for this purpose. This technique, which we illustrate, proved less cumbersome and made the graft anastomosis easy to perform. Our early experience (1969 through 1972) in operating on 199 patients resulted in an operative mortality rate of 4.5% (9/199). From 1973 through 1985, improved patient selection and use of the left internal thoracic artery as the conduit of choice for bypass of the left anterior descending coronary artery reduced the operative mortality rate for 534 patients to 1.3% (7/534). Routine postoperative angiograms were not performed; therefore, the graft patency rate is not available. However, an ongoing 34-year follow-up study of the 264 patients who underwent a single left anterior descending bypass showed the saphenous vein graft to be open in 64.3% (18/28) patients and the left internal thoracic graft in 92.2% (59/64) of patients studied. Seventy-four of the 264 patients in this study were still alive in 2003.