Creative arterial bypass grafting can be performed on the beating heart

Background. To demonstrate that compromise is unnecessary in either the des ign or performance of beating heart surgery, we report our experience, over 1 year, of total arterial revascularization. where composite or creative g rafting was utilized. Methods. We performed 321 off-pump coronary artery bypass operations, of wh ich, 290 (90%) were done with only arterial conduits. The mean number of di stal anastomoses was 2.48, with a range of I to 5. There were no aortic ana stomoses. One hundred eighty-nine patients (65%) were male, and 101 (35%) w ere female, with a mean age of 67 years. Comorbidities included chronic ren al failure (CRF), 21 (7%); diabetes, 92 (32%); obesity, 68 (23%); hypertens ion, 212 (73%); chronic obstructive pulmonary disease, 189 (65%); cerebral vascular accident (CVA), 39 (13%); smoking, 164 (56%); and hypercholesterol emia, 151 (52%). The mean ejection fraction was 56%, with a range of 21% to 71%. All procedures were performed with external stabilizers with or witho ut vacuum assist. The complete arterial revascularizations included a T-gra ft (internal thoracic [ITA]/radial arteries [RA]), 130 (45%); a sequential graft (ITA +/- RA), 118 (41%); a U-graft (coronary-coronary graft perfused by the ITA or right gastroepiploic artery), 5 (2%); an I-graft (ITA/RA), 4 (1%); an X-graft (ITA/RA), 2 (12); and a Y-graft (ITA/RA), 31 (10%). Results. The postoperative incidence of atrial fibrillation was 80 of 290 ( 27%); CVA, 5 of 290 (2%); bleeding resulting in take-back, 5 of 290 (2%); C RF, 8 of 290 (3%); deep sternal infection, 4 of 290 (1%); and readmission ( 30-day) for angina, 4 of 290 (1%). The observed perioperative (30-day) mort ality was 9 of 290 (3.1%), with the STS predicted rate of 3.82%. Conclusions. Our experience indicates that once the operating surgeon has l earned to safely expose the lateral and inferior walls of the heart, the ty pe of conduit and the method of revascularization should be no different th an that used with cardiopulmonary bypass. However, we still recommend conve ntional methods of revascularization (on-pump with saphenous vein conduits) for the ischemic patient. (C) 2001 by The Society of Thoracic Surgeons.