Off-pump bypass grafting is safe in patients with left main coronary disease

Background. Because of a concern about the ability to tolerate beating hear t grafting, patients with left main coronary artery stenosis have been excl uded from off-pump bypass. We reviewed our experience with off-pump coronar y artery bypass grafting for patients with left main coronary artery diseas e. Methods. Eight hundred twenty-three patients underwent bypass grafting for left main coronary artery disease from January 1998 to October 1999. One hu ndred patients were revascularized without the use of cardiopulmonary bypas s and compared with a contemporaneous cohort of 723 patients who underwent grafting with the aid of cardiopulmonary bypass. All patients had multivess el grafting performed through a sternotomy. Results. There was one death (1%) in the group under-going off-pump graftin g as compared with a 30-day mortality of 4.7% (p = 0.059) in the on-pump gr oup. Univariate analysis established that patients revascularized without c ardiopulmonary bypass were significantly less likely to require postoperati ve inotropic support (23% versus 62%, p < 0.001) and transfusion (35% versu s 67%, p < 0.001). Logistic regression analysis revealed that cardiopulmona ry bypass was an independent risk factor for mortality (odds ratio, 7.3; 95 % confidence interval, 1.34 to 138.4). Conclusions. Coronary artery bypass grafting using off-pump techniques are safe and effective in left main coronary artery disease. (C) 2001 by The So ciety of Thoracic Surgeons.