Routine Off-pump Total Arterial Coronary Revascularization.
- Author:
Jae Won LEE
1
;
Nam Hee PARK
;
Seong Sik KANG
;
Suk Jung CHOO
;
Seung Jung PARK
;
Seung Wook PARK
;
Myeong Ki HONG
;
Hyun SONG
;
Meong Gun SONG
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea. sjchoo@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Minimal invasive surgery;
Coronary artery bypass;
Conduit, arterial;
Conduit
- MeSH:
Cardiomegaly;
Cardiopulmonary Bypass;
Coronary Artery Bypass;
Coronary Vessels;
Gastroepiploic Artery;
Hemodynamics;
Hemorrhage;
Humans;
Myocardial Infarction;
Transplants;
Veins
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2003;36(5):309-315
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: To avoid the adverse effects of cardiopulmonary bypass and to overcome late vein graft failure, we routinely performed off-pump total arterial coronary revascularization. MATERIAL AND METHOD: From July 2000 to August 2001, 104 consecutive patients underwent first elective off-pump total arterial coronary revascularization. Both internal mammary, radial and gastroepiploic arteries were used. Sequential and composite grafts were used to achieve complete revascularization. Perioperative adverse events and postoperative angiograms were analyzed. RESULT: A total of 252 arterial conduits were used with an average of 2.47 grafts per patient. A total of 326 distal anastomosis were performed with a mean of 3.13 distal anastomosis per patient. Cross over to on-pump occurred in seven patients (6.7%). Of these 4 were due to unstable hemodynamics during lateral or posterior wall stabilization as a result of cardiomegaly and 3 were due to uncontrolled bleeding during dissection of diffusely dimunitive deeply placed intramyocardial coronary arteries. There were no opeartive deaths. Two cases of perioperative myocardial infarction and transient neurologic complications occurred, respectively. Of the 312 distal anastomoses, 308 (98.7%) were compatible with Fitz-Gibbon A or B patency grading. CONCLUSION: Off-pump total arterial coronary revascularization was technically feasible in most elective cases with satisfactory early results. However, on-pump coronary bypass surgery should be considered in difficult circumstances, such as cardiomegaly or unfavorable anatomy of the target coronary artery.
