Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome

Objectives: To determine whether patients with critical left main stem (LMS ) coronary artery disease can undergo off-pump coronary artery bypass (OPCA B) surgery safely and successfully. Methods: From May 1996 to March 2000 da ta for patients with critical (greater than or equal to 50%) LMS stenosis w ho underwent conventional coronary artery bypass surgery with cardiopulmona ry bypass (CCAB) or without (OPCAB) were collected prospectively using the Patient Analysis & Tracking System. A reusable pressure stabilizer, intra-c oronary shunts and a single posterior pericardial stitch exposure technique were used in all OPCAB cases. Non-randomized, retrospective data analysis included demographic and preoperative risk factors, operative details, clin ical outcome and early follow-up. Results: During the study period 387 pati ents with LMS stenosis underwent surgery (OPCAB n = 75, CCAB n = 312). Grou ps were similar in terms of preoperative and intraoperative variables altho ugh CCAB patients received significantly more grafts per patient (3.1 +/- 0 .73 vs. 2.6 +/- 0.76, P less than or equal to 0.001). Mortality was similar in both groups (OPCAB 1.3% vs. CCAB 2.6%). OPCAB patients when compared to CCAB patients had a lower requirement for postoperative inotropes (12.0% v s. 38.1%, P = 0.0001), temporary postoperative pacing (2.7% vs. 10.1%, P = 0.02), and blood product transfusion (6.7% vs. 31.4%, P < 0.0001), a lower incidence of postoperative chest infection (0% vs. 6.7%, P = 0.02) and a sl ightly reduced postoperative length of stay (7.9 <plus/minus> 5.46 vs. 8.3 +/- 5.11 days, P = 0.01). At 24 months follow-up, CCAB and OPCAB actuarial survival was 94.1 +/- 1.7% and 97.7 +/- 2.3%, respectively. Conclusions: OP CAB surgery is safe and effective in patients with critical LMS disease. (C ) 2001 Elsevier Science B.V. All rights reserved.