Off-pump coronary artery bypass grafting: long term angiographic results

Although short-term results of off-pump coronary artery bypass grafting are well documented, late postoperative data are still scarce. This report provides an analysis of late postoperative control angiograms.

265 patients (231 males, 34 females; mean age: 54 +/- 10) underwent postoperative angiographic control, after an average postoperative period of 4.2 +/- 2.3 years (up to 9 years, a total of 1110 years). A total of 385 distal anastomoses on 258 internal mammary arteries (IMAs) and 127 saphenous vein grafts (SVGs) were evaluated. The primary operation was single bypass in 156 cases (62%), double bypass in 98 (34%), and triple or more bypass in 11 (4%).

Out of 258 IMAs, 241 were patent (93%), while SVG patency was 65% with 82 patent grafts out of 127 (p < 0.0001). The patency in the lateral branches (62%) and right coronary system (64%) were similar. The variables associated with graft occlusion were hypercholesterolemia (p = 0.02), poor left ventricular performance (p = 0.03), reoperation (p = 0.01), target coronary vessel caliber less than 1.5 mm (p < 0.0001), poor native coronary vessel quality (p = 0.0003) and low-grade stenosis (p = 0.02). In the poor left ventricle group, the left ventricular segmental wall motion score was improved (p = 0.004). Consequently, 47 patients underwent secondary revascularization (35 PTCA and 12 CABG). The leading indication was native coronary artery disease progression, frequently in the circumflex system, followed by graft failure. The cases with native vessel disease progression were referred to PTCA/stenting, while those with LAD graft occlusion were treated surgically.

Probably the best candidates for OPCAB are those having target vessels of good caliber and quality, and high-grade stenoses. Postoperative lipid-lowering therapy seems to be prudential.