Total Arterial Off-Pump Coronary Artery Bypass Grafting

Abstract

Background:Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting (CABG). We summarized our experience with total arterial off-pump coronary artery bypass grafting (OPCAB) and assessed the early clinical results, surgical complications, and follow-up.Methods:From January 2007 to May 2017, 508 coronary artery disease patients undergoing total arterial OPCAB were enrolled. Clinical features, approaches, outcomes of surgical treatments, and follow-up data of these patients were studied retrospectively. A total of 122 patients underwent single left internal mammary artery (IMA)-left anterior descending artery grafts, whereas the other 386 patients underwent multiple vessel grafts.Results:The average distal anastomosis was 2.34 ± 0.97 (range: 1–4). All the patients were discharged from hospital except one died. A total of 457 (90.32%) patients were followed up. In the 4-, 7-, and 10-year follow-up groups, the rate of death from any cause was 1.19%, 6.47%, and 10.67%; rate of cardiac death was 0.60%, 2.88%, and 3.33%; rate of repeat revascularization was 0.00%, 3.60%, and 8.67%; rate of ischemic symptoms was 1.79%, 7.91%, and 11.33%; and incidence of stroke was 2.38%, 4.32%, and 6.67%, respectively. Poor medication adherence was observed in 9.38% of the follow-up population.Conclusions:Total arterial OPCAB with bilateral IMA, radial artery, and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group, without a significant increase in early mortality or morbidity. Moreover, the long-term outcomes are also positive.

Lower surgical Apgar score is predictive on delirium in patients following off-pump coronary artery bypass grafting

“…With the update and progress of cardiac surgery technology, OPCABG has been more and more favored by cardiac surgeons. Although the debating of OPCABG and CABG remained, OPCABG has similar survival rate comparing with CABG presently, and it shows great advantages for some older and severe patients 1,2,[36][37][38][39] .…”

Risk factors and possible mechanisms of saphenous vein graft failure after coronary artery bypass surgery

“…The “no-touch” technique seems to retain perivascular adipose tissue, provides a protection medium for SVs, maintains the integrity of ECs, and preserves EC function. [ 6 ] Some studies have focused on the vein patency of “off-pump” CABG in comparison to “on-pump” CABG. The Randomized On/Off Bypass Trial (ROOBY) randomized 2203 patients (“on-pump” or “off-pump” CABG), and the angiographic results showed that the graft patency after 1 year of “off-pump” CABG was significantly lower than that after “on-pump” CABG.…”