How much can off-pump coronary artery bypass grafting be performed for complete revascularization using only in situ arterial conduits?

With the rapid advance of percutaneous catheter intervention, the direction taken by surgeons is not only to make coronary artery bypass grafting (CABG) less invasive but also to obtain better long-term results by using more arterial conduits. However, off-pump CABG (OPCAB) with only in situ arterial conduits such as the left and right internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA) is technically demanding for the surgeon. The purpose of this study was to demonstrate the feasibility and safety of this technique. From January 2002 to December 2002, 57 patients underwent isolated CABG without cardiopulmonary bypass, excluding minimally invasive direct coronary artery bypass (MIDCAB) cases. There were 44 men and 13 women with a mean age of 64.1 years. Most of the patients (95%) underwent postoperative angiography within 1 month after surgery. The mean number of anastomoses was 3.8 +/- 1.4 (range 2-8). One patient suffered from mediastinitis and another from stroke. All patients were discharged from the hospital. Fifty patients (88%) received only in situ grafts for complete revascularization. Forty-one patients received bilateral ITAs and 27 received bilateral ITAs and RGEA. The mean number of anastomoses using bilateral ITAs and RGEA was 4.5 +/- 1.2 (range 3-8). The patency rate was 98%. Complete arterial revascularization with only in situ arterial conduits was associated with minimal operative risk and a high early graft patency rate, even in the off-pump situation. These results indicate that complete revascularization can be achieved in OPCAB with the exclusive use of in situ arterial conduits in patients with diffuse coronary arterial disease.