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Off-pump bypass surgery: the early experience, 1969-1985
1Division of Cardiothoracic Surgery, University Hospitals, 11100 Euclid Ave., Cleveland, OH 44106, USA. drankeney@aol.com
Texas Heart Institute Journal
|November 26, 2004
Summary
Off-pump coronary artery bypass surgery using a suture technique showed improved outcomes over time. The left internal thoracic artery graft demonstrated superior long-term patency compared to saphenous vein grafts.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Review of 733 patients undergoing off-pump coronary artery bypass (CABG) surgery between 1969 and 1985.
- Focus on bypass of the right coronary artery (RCA) and left anterior descending (LAD) coronary artery.
- Comparison of single vs. double bypass procedures.
Observation:
- A 4-suture technique was used for vessel stabilization, contrasting with modern mechanical devices.
- Early surgical mortality (1969-1972) was 4.5% (9/199).
- Later period (1973-1985) showed reduced mortality to 1.3% (7/534) due to improved patient selection and conduit choice.
Findings:
- The left internal thoracic artery (LITA) was favored as the conduit for LAD bypass.
- Long-term follow-up of single LAD bypass patients revealed 64.3% saphenous vein graft (SVG) patency and 92.2% LITA graft patency.
- 74 of 264 single LAD bypass patients were alive in 2003, indicating long-term survival.
Implications:
- The historical 4-suture technique facilitated graft anastomosis.
- LITA grafts offer superior long-term patency and durability compared to SVGs in off-pump CABG.
- This study highlights the evolution of surgical techniques and conduit selection in off-pump CABG, impacting patient outcomes.