Systematic off-pump coronary artery revascularization: experience of 275 cases

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Background. The author reports his short-term experience with systematic off-pump coronary artery revascularization in multivessel disease. Methods. Between September 1996 and October 1998, 275 off-pump revascularizations (83% of case load during this period; 97% since January 1998) were performed by a single surgeon (R.C.). The patient base of 216 men/59 women averaged 63 ± 10 years. Main indication was unstable angina (60%). All surgeries were performed through a median sternotomy, with mechanical stabilization, and a heart “verticalizing” technique to enable access to the circumflex territory. Results. An average of 2.91 ± 0.83 (range 1 to 5) grafts/patient was achieved, with 70% of cases being triple or quadruple bypasses. Single or double internal thoracic arteries was utilized in 95% of cases. Complete revascularization was attained in 93% of surgeries. Total ischemic time averaged 28 ± 10 (range 8 to 65) minutes. Myocardial infarction incidence was 4%, with only 1 patient requiring postoperative aortic counterpulsation assistance. One early percutaneous transluminal coronary angioplasty was needed to restore an occluded posterior descending artery. Three operative deaths resulted. One conversion to cardiopulmonary bypass was required. A transfusion rate of 32% was observed, half the rate of conventional coronary artery bypass grafting at our institute. Conclusions. With gradual experience, proper operative technique, and surgical apparatus, beating heart bypass surgery may be used systematically as a suitable, safe alternative to conventional on-pump coronary artery bypass grafting, permitting complete revascularization in a majority of patients with excellent short-term results.