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Eur J Cardiothorac Surg 2001;19:239-244
© 2001 Elsevier Science NL

Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome

Bristol Heart Institute, University of Bristol, Bristol, UK

Received 5 September 2000; received in revised form 14 December 2000; accepted 27 December 2000.

Corresponding author. Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, UK. Tel.: +44-117-928-3145; fax: +44-117-929-9737
e-mail: n.holloway-dee{at}bristol.ac.uk

Objectives: To determine whether patients with critical left main stem (LMS) coronary artery disease can undergo off-pump coronary artery bypass (OPCAB) surgery safely and successfully. Methods: From May 1996 to March 2000 data for patients with critical (50%) LMS stenosis who underwent conventional coronary artery bypass surgery with cardiopulmonary bypass (CCAB) or without (OPCAB) were collected prospectively using the Patient Analysis & Tracking System. A reusable pressure stabilizer, intra-coronary shunts and a single posterior pericardial stitch exposure technique were used in all OPCAB cases. Non-randomized, retrospective data analysis included demographic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: During the study period 387 patients with LMS stenosis underwent surgery (OPCAB n=75, CCAB n=312). Groups were similar in terms of preoperative and intraoperative variables although CCAB patients received significantly more grafts per patient (3.1±0.73 vs. 2.6±0.76, P0.001). Mortality was similar in both groups (OPCAB 1.3% vs. CCAB 2.6%). OPCAB patients when compared to CCAB patients had a lower requirement for postoperative inotropes (12.0% vs. 38.1%, P=0.0001), temporary postoperative pacing (2.7% vs. 10.1%, P=0.02), and blood product transfusion (6.7% vs. 31.4%, P<0.0001), a lower incidence of postoperative chest infection (0% vs. 6.7%, P=0.02) and a slightly reduced postoperative length of stay (7.9±5.46 vs. 8.3±5.11 days, P=0.01). At 24 months follow-up, CCAB and OPCAB actuarial survival was 94.1±1.7% and 97.7±2.3%, respectively. Conclusions: OPCAB surgery is safe and effective in patients with critical LMS disease.

Key Words: Left main stem disease • Off-pump coronary artery bypass surgery

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