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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Left main coronary artery disease does not affect the outcome of off-pump coronary artery bypass grafting
Tomoaki Suzuki1, Tohru Asai, Keiji Matsubayashi
1Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu City, Shiga, Japan. suzukit@belle.shiga-med.ac.jp
Insights
Off-pump coronary artery bypass grafting is safe for patients with left main coronary artery (LMCA) stenosis. LMCA disease does not increase risks after this procedure, even long-term.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Left main coronary artery (LMCA) stenosis (≥50%) is a known risk factor in coronary artery bypass grafting (CABG).
- Historically, LMCA disease has influenced surgical risk stratification.
- Off-pump CABG (OPCAB) offers an alternative surgical approach.
Purpose of the Study:
- To evaluate the safety and efficacy of OPCAB in patients with critical LMCA stenosis.
- To determine if LMCA disease impacts short-term and long-term outcomes after OPCAB.
- To compare clinical results between patients with and without LMCA stenosis undergoing OPCAB.
Main Methods:
- A cohort of 665 patients undergoing isolated OPCAB was analyzed.
- 237 patients with LMCA stenosis (LMCA group) were propensity score-matched with 237 patients without LMCA stenosis (non-LMCA group).
- Clinical outcomes, including 30-day mortality and 6-year freedom from adverse events, were compared.
Main Results:
- All OPCAB procedures were completed successfully without conversion to on-pump.
- 30-day mortality was low in both groups (0.8% LMCA vs. 1.7% non-LMCA).
- Six-year freedom from all-cause death (87.3% vs. 60.7%) and a composite endpoint (80.4% vs. 70.4%) showed no significant difference between groups. Chronic renal failure predicted late cardiac events.
Conclusions:
- Off-pump coronary artery bypass grafting is a feasible and safe surgical option for patients with critical LMCA stenosis.
- LMCA disease is not identified as an independent risk factor for adverse outcomes following OPCAB.
- These findings support OPCAB as a viable strategy for patients with complex coronary artery disease involving the left main artery.
Background:
Left main coronary artery (LMCA) stenosis (≥50%) has historically been recognized as a risk factor among patients undergoing coronary artery bypass grafting.
Methods:
From January 2002 to December 2008, a total of 665 patients, 268 of whom had significant LMCA disease, underwent isolated off-pump coronary artery bypass surgery at Shiga Medical University Hospital. We compared the clinical results in the 237 patients with LMCA stenosis (LMCA group) with those in the propensity score-matched 237 patients without LMCA stenosis (non-LMCA group). We performed off-pump surgery in all coronary artery bypass grafting cases with no exclusion criteria.
Results:
All procedures were performed by off-pump technique without conversion to on-pump. Two patients in the LMCA group (2 of 237; 0.8%) and four in the non-LMCA group (4 of 237; 1.7%) died within 30 days after surgery. Follow-up was completed in 96.2% of the patients. The rates of six-year freedom from all cause death were 87.3% and 60.7% in the LMCA group and non-LMCA group, respectively (p = 0.17), and the corresponding rates for the combined endpoint of cardiac death, myocardial infarction, angina pectoris, repeat coronary intervention, and heart failure were 80.4% and 70.4% (p = 0.98). Multivariate Cox regression analysis revealed chronic renal failure as a statistically significant predictor for late cardiac event.
Conclusions:
Off-pump coronary artery bypass grafting is feasible and safe in patients with critical LMCA stenosis and LMCA disease is not recognized as a risk factor after off-pump coronary artery bypass grafting in either the short or the long term.
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