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a Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore
b Department of Surgery Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore
c Department of Internal Medicine/Cardiology University of Leipzig – Heart Center, Strümpellstraße 39, 04289 Leipzig, Germany
d Department of Cardiac and Vascular Surgery, University Hospital Zurich, Raemi Street 100, 8091 Zurich, Switzerland
Received 24 October 2008; received in revised form 24 March 2009; accepted 20 April 2009.
* Corresponding author. Address: Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, 5 Lower Kent Ridge Road, level 2, Singapore 119074, Singapore. Tel.: +65 67722065; fax: +65 67766475. (Email: surtk{at}nus.edu.sg).
Background: Summary Left main disease (LMD) and associated cardiac risk factors are often perceived as a limiting factor for the outcome of off-pump coronary artery bypass (OPCAB) grafting. In this study, we assess whether the outcome of OPCAB surgery is affected in such patients. Methods: We retrospectively compared perioperative parameters in 66 OPCAB patients (group A) with LMD and 216 OPCAB patients without (group B) LMD. The patients were operated in the time frame between 2002 and 2007. LMD was defined as a stenosis >50%. Results: Patients in group A had a higher EuroSCORE (logistic: 3.7 ± 0.1 vs 6.3 ± 0.3, p = 0.027), increased coronary artery disease (CAD) family history (p = 0.015) and cerebrovascular accidents (p = 0.027), increased history of congestive heart failure (p = 0.013), more urgent surgery (p = 0.008), previous percutaneous transluminal coronary angioplasties (PTCAs) (p = 0.05) and previous stent implantation (p = 0.023). An intra-aortic balloon pump (IABP) was inserted more frequently in the LMD group preoperatively (p = 0.004). There were two conversions to on-pump during OPCAB surgery. There were no differences in the postoperative outcomes in the LMD group A versus group B, such as cardiac-related events, neurological deficits, cardiac enzyme course, arrhythmias, blood loss, infections and renal failure. Conclusions: The presence of LMD and higher EuroSCORE does not yield adverse outcomes in OPCAB patients.
Abbreviations: LMD = left main disease • LM = left main coronary artery • CX = circumflex coronary artery • RCA = right coronary artery • LITA = left internal thoracic artery • RPDA = right posterior descending coronary artery • OPCAB = off-pump coronary bypass grafting • vs = versus • CAD = coronary artery disease • PTCA = percutaneous transluminal coronary angioplasty • IABP = intra-aortic balloon pump • CPB = cardiopulmonary bypass • COPD = chronic obstructive pulmonary disease • EF = ejection fraction • AV = atrio-ventricular • MI = myocardial infarction • ICU = Intensive Care Unit • NYHA = New York Heart Association • NCP = no coronary perfusion • PCP = passive coronary perfusion • ACP = active coronary perfusion • SSI = surgical side infections • CCS Class = Canadian cardiovascular society class • CK = creatine kinase • CKMB = creatine kinase-myocardial band • EuroSCORE = European system for cardiac operative risk evaluation
Key Words: Off-pump • Coronary artery bypass grafting (CABG)
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