On-pump Beating Heart Coronary Artery Bypass Grafting Research Articles

Short-term and long-term outcomes of on-pump beating-heart coronary artery bypass surgery in dialysis and non-dialysis patients: a retrospective study in a single center

BackgroundThis study aimed to evaluate the short-term and long-term outcomes of dialysis and non-dialysis patients after On-pump beating-heart coronary artery bypass grafting (OPBH-CABG).MethodsWe retrospectively reviewed medical records of 659 patients underwent OPBH-CABG at our hospital from 2009 to 2019, including 549 non-dialysis patients and 110 dialysis patients. Outcomes were in-hospital mortality, length of stay, surgical complications, post-CABG reintervention, and late mortality. The median follow-up was 3.88 years in non-dialysis patients and 2.24 years in dialysis patients. Propensity matching analysis was performed.ResultsAfter 1:1 matching, dialysis patients had significantly longer length of stay (14 (11–18) vs. 12 (10–15), p = 0.016), higher rates of myocardial infarction (16.85% vs. 6.74%, p = 0.037) and late mortality (25.93% vs. 9.4%, p = 0.005) after CABG compared to non-dialysis patients. No significant differences were observed in in-hospital mortality, complications, or post-CABG reintervention rate between dialysis and non-dialysis groups.ConclusionsOPBH-CABG could achieve comparable surgical mortality, surgical complication rates, and long-term revascularization in dialysis patients as those in non-dialysis patients. The results show that OPBH-CABG is a safe and effective surgical option for dialysis patients.

Comparison between Off-Pump and On-Pump Beating Heart Coronary Artery Bypass Grafting.

Although coronary artery bypass grafting (CABG) is performed via three different techniques, conventional, on-pump beating heart CABG (ONBHCAB), or off-pump CABG (OPCAB), data are limited to compare ONBHCAB with OPCAB. We retrospectively investigated the postoperative cardiac biomarkers, creatine kinase-MB (CK-MB), and troponin I (cTnI), and early and late outcomes in 806 patients undergoing isolated ONBHCAB or OPCAB between February 2008 and September 2022. To eliminate the bias between different groups, propensity score matching was conducted to validate the findings. After matching, the number of each study group totaled 270 patients. In both complete and matched cohorts, early outcomes, including morbidities and mortalities, were similar. However, cTnI and CK-MB levels were significantly higher after ONBHCAB than after OPCAB with median peak cTnI of 9.85 versus 4.60 ng/mL and median peak CK-MB of 48.45 versus 17.10 ng/mL in the matched cohort, which were quite low, below the threshold for values defining perioperative myocardial infarction. At follow-up of 73 ± 45 months, the overall actuarial survival rates were similar between the ONBHCAB and OPCAB patients (86 vs. 87% at 5 years and 64 vs. 68% at 10 years, respectively, in the matched cohort). ONBHCAB may be a comparable alternative to OPCAB with similar early and late outcomes, despite higher elevation of postoperative cardiac biomarkers. ONBHCAB provides more efficient hemodynamic support, providing a better surgical visual field, than OPCAB while reducing the risk of incomplete revascularization.

Comparative efficacy on outcomes of C-CABG, OPCAB, and ONBEAT in coronary heart disease: a systematic review and network meta-analysis of randomized controlled trials.

Coronary artery bypass grafting (CABG) remains the gold standard for the treatment of multivessel and left main coronary heart disease. However, the current evidence about the optimal surgical revascularization strategy is inconsistent and is not sufficient to allow for definite conclusions. Thus, this topic needs to be extensively discussed. The aim of this present study was to compare the clinical outcomes of off-pump CABG (OPCAB), conventional on-pump CABG (C-CABG), and on-pump beating heart (ONBEAT) CABG via an updated systematic review and network meta-analysis of randomized controlled trials. PubMed, Web of Science, and the Cochrane Central Registry were searched for relevant randomized controlled trials that were published in English before 1 December 2021. Published trials that included patients who received OPCAB, C-CABG, and ONBEAT CABG were selected. Two authors independently screened the search results, assessed the full texts to identify eligible studies and the risk of bias of the included studies, and extracted data. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data. The primary outcome was postoperative mortality in patients who underwent C-CABG, OPCAB, or ONBEAT CABG. The secondary outcomes were postoperative myocardial infarction, stroke, and renal impairment in the three groups. The time point for analysis of outcomes was all time periods during the postoperative follow-up. A total of 39385 patients (83496.2 person-years) in 65 studies who fulfilled the prespecified criteria were included. In the network meta-analysis, OPCAB was associated with an increase of 12% in the risk of all-cause mortality when compared with C-CABG [odds ratio (OR): 1.12; 95% CI: 1.04-1.21], a reduction of 49% in the risk of myocardial infarction when compared with ONBEAT (OR: 0.51; 95% CI: 0.26-0.99), a reduction of 16% in the risk of stroke when compared with C-CABG (OR: 0.84; 95% CI: 0.72-0.99) and a similar risk of renal impairment when compared with C-CABG and ONBEAT. OPCAB was associated with higher all-cause mortality but lower postoperative stroke compared with C-CABG. OPCAB was associated with a lower postoperative myocardial infarction than that of ONBEAT. Early mortality was comparable among OPCAB, ONBEAT, and C-CABG.

Coronary Artery Bypass Surgery for Acute Coronary Syndrome: A Network Meta-Analysis of On-Pump Cardioplegic Arrest, Off-Pump and On-Pump Beating Heart Strategies

Coronary artery bypass grafting (CABG) in the setting of an acute coronary syndrome is a high-risk procedure, and the best strategy for myocardial revascularisation remains debated. This study aimed to compare the 30-day mortality benefit of on-pump CABG (ONCAB), off-pump CABG (OPCAB), and on-pump beating heart CABG (OnBHCAB) strategies.

Coronary artery bypass surgery for acute coronary syndrome: A network meta-analysis of on-pump cardioplegic arrest, off-pump, and on-pump beating heart strategies.

Coronary artery bypass grafting (CABG)in the setting of an acute coronary syndrome is a high-risk procedure, and the best strategy for myocardial revascularisation remains debated. This study compares the 30-day mortality benefit of on-pump CABG (ONCAB), off-pump CABG (OPCAB),and on-pump beating heart CABG (OnBHCAB) strategies. A systematic search of three electronic databases was conducted for studies comparing ONCAB with OPCAB or OnBHCAB in patients with acute coronary syndrome (ACS). The primary outcome, 30-day mortality, was compared using a Bayesian hierarchical network meta-analysis (NMA). A random effects consistency model was applied, and direct and indirect comparisons were made to determine the relative effectiveness of each strategy on postoperative outcomes. One randomised controlled trial and eighteen observational studies fulfilling the inclusion criteria were identified. A total of 4320, 5559, and 1962 patients underwent ONCAB, OPCAB, and OnBHCAB respectively. NMA showed that OPCAB had the highest probability of ranking as the most effective treatment in terms of 30-day mortality (odds ratio [OR], 0.50; 95% credible interval[CrI], 0.23-1.00), followed by OnBHCAB (OR, 0.62; 95% CrI, 0.20-1.57), however the 95% CrI crossed or included unity. A subgroup NMA of nine studies assessing only acutemyocardial infarction(AMI)patients demonstrated a 72% reduction in likelihood of 30-day mortality after OPCAB (CrI, 0.07-0.83). No significant increase in rate of stroke, renal dysfunction or length of intensive care unitstay was found for either strategy. Although no single best surgical revascularisation approach in ACS patients was identified, the significant mortality benefit with OPCAB seen with AMI suggests high acuity patients may benefit most from avoiding further myocardial injury associated with cardiopulmonary bypass and cardioplegic arrest.

Retrospective assessment of the early and medium outcomes of on-pump beating-heart versus off-pump CABG in patients with moderate left ventricular dysfunction (LVEF)

Aim: To compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. Material & Methods: This study was conducted as a retrospective observation over a period of 1 year at the Department of Cardiothoracic and Vascular Surgery, Indira Gandhi Institute of medical Sciences, Patna, Bihar, India.130 patients were selected for this study. All patients were divided into 2 groups, according to the revascularization method: OPCABG group and OPBH group. Results: LVEF before discharge significantly improved from 34.39 ± 4.21 to 44.27 ± 7.29 in the OPBH group and from 34.27±4.61 to 42.66 ± 8.20in the OPCABG group (P<0.001). All survival patients have been echocardiographically examined after 6 months which showed a significant higher early postoperative LVEF in the OPBH group than in the OPCABG group (45.28 ± 6.10 versus 44.42 ± 7.08%, respectively; P=0.002). Conclusion: The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better midterm MACE-free survival compared with OPCABG.

Features of surgical treatment of advanced age patients with coronary artery disease

To optimize surgical treatment of patients aged over 70 years with coronary artery disease. There were 398 patients aged over 70 years with coronary artery disease for the period 2006-2017. All patients were divided into 3 groups: group 1 - on-pump coronary artery bypass grafting (CABG) with cardiac arrest; group 2 - on-pump beating heart CABG, group 3 - off-pump CABG. On-pump beating heart CABG in patients over 70 years old is followed by reduced incidence of perioperative complications including acute heart failure, acute respiratory failure, neurological complications, reduced length of ICU- and hospital-stay compared with on-pump CABG and cardiac arrest. However, off-pump CABG is optimal in advanced age patients because this approach reduces duration of surgery, intraoperative blood loss, incidence of acute heart failure, neurological complications and cardiac rhythm disturbances. Postoperative annual and 5-year survival rates were 98.1 and 84.2%, respectively. Off-pump CABG is preferable in advanced age patients. Surgical treatment of these patients is characterized by high clinical efficacy in long-term period after surgery.

On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction: A Propensity-Score Matched Analysis From the ANZSCTS Database

Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction (AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring urgent or emergency revascularisation in the setting of AMI. We evaluated the early and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS National Cardiac Surgery Database. Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7 days of AMI. Of these, 77 patients (1.3%) underwent ONBEAT and 5774 (98.7%) underwent ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed for risk adjustment. Survival data were obtained from the National Death Index. Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7%) vs. ONSTOP: 256/5,774 (4.4%), p<0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery and single-vessel disease. After propensity-score matching, 30-day mortality was similar (ONBEAT: 9/77 (11.7%) vs. ONSTOP: 16/154 (10.4%), p=0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT: 17/77 (22.1%) vs. ONSTOP: 38/154 (24.7%), p=0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have incomplete revascularisation (ONBEAT: 15/77 (19.5%) vs. ONSTOP: 15/154, (9.7%), p=0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8% (95% CI 39.4-82.4%) vs. ONSTOP: 63.6% (95% CI 50.5, 74.3%), p=0.89). ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI with similar short and long-term survival compared to ONSTOP.

Myocardial revascularization among patients with severe left ventricular dysfunction: a comparison between on-pump beating-heart and off-pump coronary artery bypass grafting

Objective: To evaluate the impacts of an on-pump beating-heart versus an off-pump coronary artery bypass grafting (CABG) technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (EF) of 35% or less. Methods: A total of 216 consecutive patients with an echocardiographic estimated EF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study and were divided into either an OBCAB group (patients who received on-pump beating-heart CABG surgery, n=88) or an OPCAB group (patients who received off-pump CABG surgery, n=128). The early clinical outcomes were investigated and compared. The outcomes were compared between groups by t-test, χ2 test or Fisher's exact test, when appropriate. Results: No significant differences emerged between the two groups in baseline characteristics of the entire cohort except for more patients with diabetes and a larger left ventricular endo-diastolic diameter in the OBCAB group. Patients in the OBCAB group compared to the OPCAB group had a similar in-hospital mortality (3.4% vs. 4.7%, P= 0.741). Mean EF, as measured preoperatively and early postoperatively (before discharge), significantly improved from (31.0±2.8)% to (35.6±2.9)% (t=10.61, P=0.000) in the OBCAB group and from (31.0±2.9)% to (34.8±3.3)% (t=9.68, P=0.000) in the OPCAB group, respectively. The improvement of mean LVEF in the OBCAB group was significantly higher than that in the OPCAB group ((4.7±0.2)% vs. (3.6±0.3)%, t=29.53, P=0.000). Patients in the OBCAB group compared to the OPCAB group had a significant higher early postoperative EF ((35.6±2.9)% vs.(34.8±3.3)%, t=1.892, P=0.034) but shared a similar baseline EF ((31.0±2.8)% vs. (31.0±2.9)%, t=0.012, P=0.930). Patients in the OBCAB group compared to the OPCAB group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7±0.8 vs. 2.8±0.6, t=9.442, P=0.000; (715±187) ml vs. (520±148) ml, t=8.544, P=0.000, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Conclusion: The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated EF of 35% or less.

Coronary artery bypass grafting surgery in chronic hemodialysis patients

Background and aim Off-pump coronary artery bypass grafting (CABG) can be ideal for revascularization of chronic hemodialysis patients when the targets are easily accessible. Full revascularization usually necessitates the use of cardiopulmonary bypass (CPB) if the targets are not easily accessible. Either conventional CABG with cardioplegic arrest or on-pump beating-heart CABG can be used. The early and long-term outcomes are still controversial. We sought to compare the early and long-term outcomes of the three different methods of revascularization of this patient category. Patients and methods This was a retrospective analysis of randomized three selected equal groups, with 25 patients each revascularized with a different technique. Patients were operated from January 2008 to June 2016 in our institution. Group I underwent conventional CABG with cardioplegic arrest, group II underwent off-pump CABG, and group III underwent on-pump beating-heart CABG. Results The postoperative bleeding amount (P Conclusion Off-pump CABG when safely implemented is the best option for complete revascularization of chronic hemodialysis patients. On-pump beating-heart CABG is a safe procedure that provides optimal operative exposure in chronic hemodialysis patients. The use of CPB and the elimination of cardioplegic arrest may be beneficial for the short-term and long-term survival of chronic hemodialysis patients.

Postoperative Renal Outcomes of On-Pump Beating-Heart versus Cardioplegic Arrest Coronary Artery Bypass Grafting.

The aim of this investigation is to compare the postoperative renal outcomes after on-pump beating- heart versus conventional cardioplegic arrest coronary artery bypass grafting (CABG). Between January 2010 and December 2012, 254 patients who underwent isolated CABG were enrolled. The primary outcome was postoperative acute kidney injury (AKI) within 7 days [defined by the Kidney Disease Improving Global Outcome (KDIGO) Clinical Practice Guideline] and loss of kidney function at 1 year (defined as > 20% loss in estimated glomerular filtration rate from baseline preoperative creatinine level). There was less AKI found for the on-pump beating-heart CABG (30.2% versus 46.3%; p = 0.010) group; with significant less stage I AKI (17.6% versus 29.5%; p = 0.035); a trend of less stage II AKI (4.4% versus 10.5%; p = 0.088) and no significant difference in stage III AKI (8.2% versus 6.3%; p = 0.587). The on-pump beating-heart group also had less patients who have lost their kidney function at 1 year (24.8% versus 41.2%; p = 0.021). Furthermore, multivariate analysis identified conventional arrest CABG is an independent risk factor for postoperative AKI and loss of kidney function at 1 year. On-pump beating-heart CABG has superior short-term and mid-term renal outcomes than conventional cardioplegic arrest CABG.

Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center

BackgroundLimited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction.MethodsA total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared.ResultsPatients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less.ConclusionsThe on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.

On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis.

A hybrid procedure of beating-heart coronary artery bypass grafting (CABG) with the concomitant use of cardiopulmonary bypass termed on-pump beating-heart CABG (ON-BH CABG) has emerged as an alternative for high-risk patient populations. Although several studies have reported the advantage of ON-BH CABG in high-risk patients, the clinical benefit of ON-BH CABG is still under discussion. Here, we performed a meta-analysis of the data derived from published studies comparing the clinical outcomes of ON-BH CABG with that of conventional arrested heart CABG. Medline, Embase and Scopus databases were searched for relevant publications up to March 2015. A systematic review of the published literature identified 14 published studies incorporating 2040 patients (884 ON-BH CABG and 1156 conventional CABG). Odds ratios (ORs) for binary variables or weighted mean difference for continuous variables were combined using the inverse variance method in a fixed-effects model. Study heterogeneity was tested using Cochran's Q test and the publication bias was assessed using Begg's and Egger's tests. The fixed-effects meta-analysis for early mortality showed that ON-BH CABG provided a 45% lower risk of early mortality compared with conventional CABG (OR 0.553; 95% confidence interval [CI] 0.376-0.815; P = 0.003). There was minimal heterogeneity in the included studies (P = 0.29) and no evidence of significant publication bias. A sensitivity analysis, including a random-effects meta-analysis (OR 0.552; 95% CI 0.356-0.856; P = 0.008) and a one-study-removed meta-analysis, supported the validity of the primary analysis for early mortality. There was significantly lower perioperative morbidity associated with ON-BH CABG, including myocardial infarction (OR 0.294; 95% CI 0.141-0.613; P = 0.001), renal failure (OR 0.362; 95% CI 0.209-0.626; P < 0. 001) and low output syndrome (OR 0.330; 95% CI 0.197-0.551; P < 0.001) with no significant heterogeneity. In conclusion, current evidence from comparative studies indicates that ON-BH CABG is associated with significantly lower early morbidity and mortality. The ON-BH CABG could be an attractive planned alternative for high-risk patient populations.

Prognosis of different operative procedures of coronary artery bypass grafting in the senile patients

To investigate myocardial protection and prognosis of the different operative procedures of coronary artery bypass grafting (CABG) for the senile patients with coronary artery disease. From July 2008 to June 2009, 125 cases (age ≥ 65 years old) underwent CABG were divided into 3 groups.Group A (70 cases) undertook off-pump CABG, group B (33 cases) undertook on-pump beating heart CABG. group C (22 cases) undertook on-pump CABG with cardiac arrest. Serum level of cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) activity were examined right before operation and 0, 24, 72 and 168 h after operation. The complications during perioperative period and the mortality were investigated. No significant difference was found in the right before operation and 168 h after operation of the serum level of cTnI and CK-MB in the 3 groups (P > 0.05). The serum level of cTnI and CK-MB activity of group A was the lowest and group B was lower than group C. Group A was the best concerning the complications during perioperative period. The mortality of group A was lower than group B but no significant difference was found in the mortality between group A and C. No significant difference was found in the complications during perioperative period and the mortality between group B and C. Off-pump CABG could reduce myocardial injury and the complications during perioperative period in the senile patients.

A Randomized Trial of On-Pump Beating Heart and Conventional Cardioplegic Arrest in Coronary Artery Bypass Surgery Patients With Impaired Left Ventricular Function Using Cardiac Magnetic Resonance Imaging and Biochemical Markers

Beating heart coronary artery bypass grafting (CABG) improves early postoperative cardiac function in patients with normal ventricular function, but its effect in patients with impaired function is uncertain. We compared a novel hybrid technique of on-pump beating heart CABG (ONBEAT) with conventional on-pump CABG (ONSTOP) in patients with impaired ventricular function. In a single-center randomized trial, 50 patients with impaired ventricular function were randomly assigned to ONBEAT or ONSTOP. Patients underwent cardiac magnetic resonance imaging for function and delayed hyperenhancement early and later after surgery. Serial assessment of biochemical markers was also undertaken. Preoperative characteristics were well matched; cardiac index was 2.85+/-0.53 (ONBEAT) and 2.62+/-0.59 L x min(-1) x m(-2) (ONSTOP). Early after surgery, there was a trend toward a greater reduction in end-systolic volume index in ONSTOP patients versus ONBEAT (-9+/-8 versus -4+/-11 mL x m(-2); P=0.06). The changes were sustained and significant at 6 months (-14+/-18 versus -2+/-19 mL x m(-2); P=0.04). Furthermore, the incidence of new hyperenhancement at 6 days was higher in ONBEAT patients (P=0.05), with 6 of 17 (35%) sustaining 8.2+/-5.2 g of new hyperenhancement each versus 2 of 23 (9%) in the ONSTOP group, each with 9.8+/-9.0 g (P=0.86). Finally, median area under the curve for troponin was higher in ONBEAT at 461 (interquartile range, 226 to 1141) microg/L versus 160 (interquartile range, 98 to 357) microg/L for ONSTOP (P=0.002). The incidence of new irreversible myocardial injury was significantly higher in ONBEAT than in ONSTOP patients. Furthermore, at 6 months, only ONSTOP patients demonstrated an improvement in ventricular geometry. The most likely mechanism is inadequate coronary perfusion to distal myocardial territories in patients with severe proximal coronary disease.

Beating heart coronary artery bypass grafting: results from 402 patients and the usefulness of gastroepiploic artery composite grafting.

We have studied the results of 402 consecutive cases of beating heart coronary artery bypass grafting (CABG) and evaluated the usefulness of gastroepiploic artery (GEA) composite grafts. Between March 1993 and August 2001, 402 patients underwent beating heart CABG. They were 321 male and 81 female patients, aged 17 to 88 (mean 66) years. Beating heart CABG was facilitated by mechanical stabilization with a doughnut stabilizer, a newly designed sternal retractor and a new coronary perfusion system. Minimally invasive direct coronary artery bypass (MIDCAB) was performed in 206 patients (the MIDCAB Group), and beating heart CABG with median sternotomy (OPCAB) was performed in 196 patients (the OPCAB Group). Definite off-pump CABG was accomplished in 381 patients. 21 patients (5%) were converted to on-pump beating heart CABG using percutaneous cardiopulmonary system via femoral vessels because of hemodynamic instability. There was 1 operative mortality (0.2%). There was perioperative myocardial infarction in 2 (0.5%), and cerebral infarction in 3 (0.7%). The rate of complete revascularization was 78% in the MIDCAB Group and 97% in the OPCAB Group. The mean number of anastomoses was 1.6 in the MIDCAB Group and 3.3 in the OPCAB Group. The early graft patency was 99.1% in a left internal thoracic artery graft, 97.0% in a right internal thoracic artery graft, 96.5% in GEA, 98.2% in a radial artery graft, and 94.2% in a vein graft. A GEA composite graft was used in 55 of the 168 patients who received GEA grafting. The mean number of anastomoses for the GEA composite graft was 1.6 +/- 0.6 per patient. The graft patency rate was 94.6% (53/56) for GEA and 98.6% (72/73) for the radial artery used as a composite graft. A consecutive series of beating heart CABG was performed safely and effectively with a low mortality rate and low morbidity rate. Beating heart CABG could be performed in all patients, and definite off-pump CABG was accomplished in 95% of them. In order to aim for complete revascularization, GEA composite graft was found to be effective since it required a low mean number of 1.6 anastomoses and a satisfactory patency rate at the same time.