Off-pump coronary bypass grafting is safe and efficient in patients with left main disease and higher EuroScore

Summary Left main disease (LMD) and associated cardiac risk factors are often perceived as a limiting factor for the outcome of off-pump coronary artery bypass (OPCAB) grafting. In this study, we assess whether the outcome of OPCAB surgery is affected in such patients.

We retrospectively compared perioperative parameters in 66 OPCAB patients (group A) with LMD and 216 OPCAB patients without (group B) LMD. The patients were operated in the time frame between 2002 and 2007. LMD was defined as a stenosis >50%.

Patients in group A had a higher EuroSCORE (logistic: 3.7+/-0.1 vs 6.3+/-0.3, p=0.027), increased coronary artery disease (CAD) family history (p=0.015) and cerebrovascular accidents (p=0.027), increased history of congestive heart failure (p=0.013), more urgent surgery (p=0.008), previous percutaneous transluminal coronary angioplasties (PTCAs) (p=0.05) and previous stent implantation (p=0.023). An intra-aortic balloon pump (IABP) was inserted more frequently in the LMD group preoperatively (p=0.004). There were two conversions to on-pump during OPCAB surgery. There were no differences in the postoperative outcomes in the LMD group A versus group B, such as cardiac-related events, neurological deficits, cardiac enzyme course, arrhythmias, blood loss, infections and renal failure.

The presence of LMD and higher EuroSCORE does not yield adverse outcomes in OPCAB patients.