Role of off-pump coronary artery bypass grafting in patients with malignant neoplastic disease

Although the long-term benefits of conventional coronary artery bypass graf ting (CABG) are obvious, postoperative morbidity and mortality and the leng th of recovery associated with cardiopulmonary bypass are the main concerns of cardiac surgeons and cardiologists. The aim of this study was to demons trate the effectiveness and advantage of the off-pump CABG for patients wit h concomitant malignant disorders requiring myocardial revascularization. F rom March 1997 to February 1999, 51 patients underwent off-pump CABG. Of th ese, there were 9 patients who had concomitant malignant disease requiring noncardiac surgery: gastric cancer (4), urinary bladder cancer (2), cholang ioma (1), lung cancer (1) and colon cancer (1). Off-pump CABG was performed through a sternotomy, left thoracotomy or subxiphoid incision. Five patien ts received single grafting and 4 received double. The mean operative time for the off-pump CABG was 167 min. The total amount of bleeding during the off-pump CABG was 450-890 mi. Simultaneous noncardiac operations were carri ed out in 5 patients. The other 4 patients underwent subsequent operations for the malignancy uneventfully. In contrast, of the 4 patients with concom itant malignant disorders who underwent standard CABG during the period bef ore the use of off-pump CABG, 2 died without undergoing the subsequent nonc ardiac operation. Off-pump CABG is quite efficient and is of great advantag e in patients with malignancy who require myocardial revascularization in a ddition to noncardiac surgery for the cancer.