Off-pump coronary artery bypass grafting: Single center experience with 1,000 consecutive patients

Oren Lev-Ran, Dmitri Pevni, Nahum Nesher, Ram Sharony, Yosef Paz, Amir Kramer, Rephael Mohr, Gideon Uretzky

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Advances in surgical techniques and retractor-stabilizer devices allowing access to all coronary segments have resulted in increased interest in off-pump coronary artery bypass. The residual motion in the anastomotic site and potential hemodynamic derangements, however, render this operation technically more demanding. Objectives: To evaluate the OPCAB experience in a single Israeli center. Methods: Between 2000 and 2003 in our institution, 1,000 patients underwent off-pump operations. Patients were grouped by the type of procedure, i.e., minimally invasive direct coronary artery bypass or mid-sternotomy OPCAB. Results: One hundred MIDCAB operations were performed. Of the 900 OPCAB, 767 patients received multiple grafts with an average of 2.6 ± 0.6 grafts per patient (range 2-4) and the remaining patients underwent single grafting during hybrid or emergency procedures. In the multiple-graft OPCAB group, complete revascularization was achieved in 96%. Multiple arterial conduits were used in 76% of the patients, and total arterial revascularization without aortic manipulation, using T-graft (35%) or in situ configurations, was performed in 61%. The respective rates for early mortality, myocardial infarction and stroke in the MIDCAB were 1%, 0% and 2%, and 2%, 1.3% and 0.9% in the multiple-vessel OPCAB groups. Multivariate analysis identified renal dysfunction (odds ratio 11.5, confidence interval 3.02-43.8; P < 0.0001) and emergency operation (OR 8.74, CL 1.99-38.3; P = 0.004) as predictors of mortality. The proportion of off-pump procedures increased from 9% prior to the study period to 59%. Conclusions: The use of OPCAB does not compromise the ability to achieve complete myocardial revascularization. Our procedure of choice is OPCAB using arterial conduits, preferably the 'no-touch' aorta technique.

Original languageEnglish
Pages (from-to)665-669
Number of pages5
JournalIsrael Medical Association Journal
Volume6
Issue number11
StatePublished - 1 Nov 2004
Externally publishedYes

Keywords

  • Arterial conduits
  • No-touch aorta
  • Off-pump coronary artery bypass grafting

Fingerprint

Dive into the research topics of 'Off-pump coronary artery bypass grafting: Single center experience with 1,000 consecutive patients'. Together they form a unique fingerprint.

Cite this