Introduction of an OPCAB program aimed at total arterial grafting in a multidisciplinary setting: feasible and safe?

The feasibility and the results of the introduction of an off-pump coronary artery bypass (OPCAB) program aimed at total arterial revascularization in a multidisciplinary institution were analyzed. Uniform surgical and anesthetic protocols were established and applied throughout the study period.

From March 2003--when the first OPCAB procedure of the program was performed--to July 2004, the data related to all the coronary artery bypass grafting procedures (N = 408) were prospectively recorded. The program was divided into two stages: the purpose of the first stage was to perform OPCAB in more than 90% of the patients, and that of the second stage was to proceed toward total arterial revascularization. The patients were grouped into four periods (102 patients for each period). Comparisons were performed with analysis of variance test and chi-square test where appropriate.

For periods 1 to 4, the number of OPCAB procedures was 65/102 (64%), 82/102 (80%), 97/102 (95%), and 99/102 (97%), respectively (p < 0.001). The number of conversions did not vary significantly throughout the study (overall: 7/408, 1.7%), neither did the number of bypass/patient (overall: 3.05 +/- 0.86). The number of arterial graft/patient was 1.03 +/- 0.64, 1.01 +/- 0.4, 1.29 +/- 0.64, and 2.56 +/- 1, respectively (p < 0.001). During the last period, 81% (253/312) of the grafts were arterial. Overall mortality was 4.6% (19/408). For the OPCAB group, mortality was 2.9% (10/343) and perioperative myocardial infarction rate was 1.5% (5/343) with no statistically significant difference between the periods.

With predefined standardized and coordinated protocols, an OPCAB program aimed at total arterial revascularization can be implemented rapidly and safely in a multidisciplinary setting.