Midterm angiographic assessment of coronary artery bypass grafting withoutcardiopulmonary bypass

Background. Coronary bypass surgery that provides good long-term graft pate ncy fan be performed on the beating heart as a viable alternative to conven tional coronary artery bypass grafting (CABG). Methods. From September 1993 to December 1996, 696 patients underwent CABG on the beating heart at the Kosuyolu Heart and Research Hospital in Istanbu l. Among them, 70 patients were chosen randomly for angiographic assessment of off-pump coronary artery bypass grafting. Results. The interval from operation to angiography varied from 24 to 61 mo nths (mean, 36.1 +/- 10.9 months). The patency rate of left internal mammar y-left anterior descending artery anastomoses was 95.59% (patency achieved in 65 of 68 patients) and of vein grafts was 47.06% (patency achieved in 16 of 34 patients) (p < 0.0001). The patency rates of grafts anastomosed to t he left anterior descending artery were significantly higher than the rates of the grafts anastomosed to the other corollary arteries (95.71% versus 4 5.45%, p < 0.0001). Multivariate analysis showed that graft type (p < 0.000 1) and hyperlipidemia (p = 0.023) were significant predictors for graft occ lusion. Left ventricular function improved significantly after CABG (p = 0. 04). Reintervention (using percutaneous transluminal cardiac angioplasty) a nd reoperation rates were 0.97% and 1.4% respectively. Conclusions. Off-pump coronary artery bypass grafting appears to produce mi dterm and long-term patency rates that are comparable to those of conventio nal techniques; that is especially true in cases of arterial conduits and o f conduits anastomosed to the left anterior descending artery. (Ann Thorac Surg 2000;70:844-50) (C) 2000 by The Society of Thoracic Surgeons.