On-pump versus off- pump complete arterial revascularization as a routine approach: clinical resuts up to 8 years

• Published in: The Thoracic and Cardiovascular Surgeon
• Main Authors: Rieß, FC, Knapp, B, Awwad, N, Bader, R, Hansen, L, Löwer, C, Winkel, S
• Format: Conference Proceeding
• Language: English
• Published: 01.02.2010
• ISSN: 0171-6425; 1439-1902
• DOI: 10.1055/s-0029-1246696

Objectives: Using both skeletonized internal mammary arteries and T-graft technique it is possible to perform complete arterial coronary artery bypass grafting (CACABG) as a routine approach. Methods: Between 1/2000 and 12/2007 a total number of 2076 non-selected consecutive patients (aged 66.3±10.1 years, 20.3% female) underwent isolated CACABG. These patients were investigated retrospectively by an questionaire and telephone interview. Patients were treated by single-LIMA on-pump (group I, 79 patients 3.8%), single-LIMA off-pump (group II, 362 patients, 17.4%), LIMA-RIMA-T-graft on-pump (group III, 1299 patients, 62.6%), or LIMA-RIMA-T-graft off-pump (group IV, 336 patients, 16.2%). Results: The following results were found in the four different groups: mean number of anastomoses 1.7±0.6, 1.2±0.4, 3.5±0.8, and 2.9±0.8; 30-days-mortality 1.3%, 0.8%, 1.4%, and 0.3%, rate of perioperative myocardial infarctions 1.3%, 0.6%, 0.6%, and 0.0%; sternal wound infections 1.3%, 0.0%, 0.8%, and 0.6%. Postoperative coronary angiogram, performed in 176 symptomatic patients documented patency rates according to FitzGibbon classification of 81.8%, 97.4%, 91.1%, 93.9%, respectively. Quality of life (SF 36 questionaire) showed satisfactory results in all groups. Death rates were 0.5%, 1.2%, 0.7%, and 0.8%/pt yr. During the entire 8 years follow-up re-intervention with PCI (native vessel or bypass) was necessary in 0, 4, 11, and 1 patients, and re-operation was performed in 1, 0, 0, and 1 patient in the four different groups, respectively. Conclusions: CACABG by use of single LIMA or LIMA/RIMA-T-graft technique is a safe and effective approach for non-selected patients with excellent clinical results up to 8 years.