6. OFF-PUMP BYPASS GRAFTING IS SAFE IN PATIENTS WITH LEFT MAIN CORONARY DISEASE
Todd Dewey, James Edgerton, Megumi Mathison, Denise Tennison, Mitchell Magee, Michael J. Mack*
CRSTI
Dallas, Texas, USA
BACKGROUND
Due to a perceived inability to tolerate beating heart grafting, patients with left main stenosis historically have been excluded from off pump revascularization. We reviewed our experience with off pump coronary artery bypass grafting for patients with significant left main stenosis.
MATERIAL AND METHODS
Between January 1998 and May 1999, 592 patients underwent bypass grafting for left main coronary disease. Sixty-five patients were revascularized using off pump techniques and compared to a contemporaneous cohort of 527 patients who underwent grafting using cardiopulmonary bypass (CPB). All patients had multivessel grafting performed via sternotomy.
RESULTS
No mortality was observed in those patients undergoing beating heart grafting compared to a 30-day mortality of 2% (10/527) for those using CPB. Univariate analysis established that patients revascularized without CPB were less likely to require inotropic support (27% vs 66%, P<0.01). There were no significant differences in terms of transfusion requirements, intra-aortic balloon pump use, or reoperations for bleeding. There was a trend toward fewer neurologic events in the off pump group.
CONCLUSION
Transient periods of regional ischemia are well tolerated in this population as demonstrated by a decreased requirement for inotropic support. Coronary artery bypass grafting using off pump techniques is safe and effective in left main coronary artery disease.
