Off-Pump Coronary Artery Grafting in Patients Necessitating Multiple Distal Anastomoses

Abstract

Objectives: Off-pump surgery has become a valuable alternative if a small number of distal anastomoses is required. The aim of the present study was to test the hypothesis that outcome is not altered in multiple distal anastomoses.Material and methods: During a 4 year period, 350 patients were operated off-pump. 187 patients received one or two distal anastomoses (group A), and 163 patients received more than two distal anastomoses (group B). Pre-operative characteristics, intra-operative details and postoperative outcome were reviewed.Results: In group A, 1.8 ± 0.4 distal anastomoses were performed, versus 3.2 ± 0.5 in group B (P < 0.001). There were more sequential distal anastomoses in group B (1.09 in group A versus 1.38 in group B) with a wider use of right internal thoracic and radial arteries. There were more anastomoses performed on the lateral (89% vs. 45%) and on the inferior wall (65% vs. 16%) in group B, compared with group A. The operation time was significantly longer (206 ± 75 minutes versus 158 ± 33 minutes) and the operative blood loss significantly higher (748 ± 516 ml versus 509 ± 361 ml) in group B. Total blood loss, transfusion requirements, neurological disfunction, hospital stay, troponine I level, postoperative infarction and 30 days mortality did not differ significantly between groups. There were 11 conversions (3.1%), 3 patients in group A and 8 patients in group B (NS). Most conversion occurred imperative while performing an anastomosis on the anterior wall.Conclusion: Beating heart surgery with multiple distal anastomoses, can be performed without increased myocardial damage, postoperative morbidity or hospital mortality. Lateral wall grafting could not be identified as a trigger for conversion.