Off-pump total arterial revascularization with both internal thoracic arteries without extracorporeal circulation

Introduction. Tector has described the off-pump total arterial revasculariz ation technique, using multiple anastomosis with both internal thoracic art eries. To reduce surgical morbid-mortality, we have proposed the use of thi s technique without extracorporeal circulation. Patients and methods. From April, 1998 the off-pump Tector technique was pe rformed in 92 patients, 74 male (80%) and 18 female (20%), with a mean age of 64.9 +/- 8.1 years (42-78). Preoperative angiography demonstrated triple -vessel disease in 58 (63%) patients, and left main disease was present in 19 (20.5%) patients. Forty patients (43.5%) showed unstable angina, 24 pati ents (26%) significant peripheral vascular disease, and 26 (28%) diabetes m ellitus. Both internal thoracic arteries were harvested using the skeletoni zation technique and were used like a "T or T" graft. The flow in the graft was measured using a flowmeter, and in 24 (26%) patients by angiographic s tudy. Results. A total of 274 distal anastomoses were performed, 122 (44.6%) in t he lateral or inferior wall, and 69 (25.2%) were sequential, with an averag e of 2.98 bypass/patient. In 59.8% of the patients a triple bypass was perf ormed, 22% double bypass, 17% cuadruple bypass and 1 patient a quintuple by pass. During the initial six hours 64.9% of patients were extubated. Only o ne patient (1.1%) needed intraaortic ballon pumping and 3 (3.2%) inotropics during the postoperative course. Hospital mortality was 3 (3.2%) patients. Reoperation for bleeding was needed in just one patient (1.1%), and 78.3% of patients were not transfused. Mediastinitis occurred in 3 patients (3.2% ). Postoperative stroke was not observed. At 7.7 +/- 2.8 months of mean fol low-up all patients were free of symptoms and the global patency rate of 94 %. Conclusions. Off-pump Tector technique appears to be safe, offering a compl ete arterial revascularization and showing a reduction of surgical morbidit y.