Case series of off-pump coronary artery bypass grafting involving 3703 patients / 中华胸心血管外科杂志

ABSTRACT

Objective To summarize our experience with off-pump coronary artery bypass grafting (OPCAB) during previous 13 years. Methods Data from 3703 patients who underwent OPCAB between October 1996 and December 2008 were collected and analyzed in this study. Following perioperative variables were reviewed and evaluated: changes in the number of patients, demographic characteristics of patients, coexisting conditions such as hypertension, and diabetes, grafting options,numbers of grafts per patient, and postoperative complications and clinical outcomes. Patients were divided into four age subgroups: those who were less than 45 years were assigned to group 1, those who were 45 to 60 years were assigned to group 2,those who were 60 to 75 years were assigned to group 3, and those older than 75 years of age were assigned to group 4. Perioperative data, including the use of internal mammary artery and the constituent of the grafts, were collected retrospectively and analyzed. Results Three thousand and twenty-five patients were male (81.7%) and 678 were female ( 18.3% ), mean age was (61.35 ±9.38) years old. The number of patients who underwent OPCAB increased steadily over time. The mean grafts per patient were 3.3 ± 0.8. The use of left internal mammary artery and "hybrid" bypass grafts composed of vein and artery played a predominant role in this cohort (P<0.05) . During this period of 13 years, intra-aortic balloon counterpulsation (IABP)was performed in 41 patients and continuous renal replacement therapy (CRRT)was required in 12 patients. Main complications included rethoracotomy for bleeding and tamponade in 1.49% of patients, deep sternal wound infection requiring re-exploration in 1.38%, perioperative myocardial infarction in 1.03%, neurological adverse events in 0.62%, tracheotomy in 0.59%, acute renal dysfunction in 0.77%, and other complications in 0.77%. The overall in-hospital mortality was 0.7% (26 of 3703 patients). A trend toward a reduction in morbidity and mortality was shown in this study. Diseases associated with hospital mortality were cardiac sudden death, multiple organ dysfunction syndrome, low cardiac output syndrome, severe infection, extensive myocardial infarction and neurological adverse events. Conclusion The indications for OPCAB, an innovative revascularization strategy, have been expanded and the curative rate for OPCAB has been improved in recent years. Appropriate and practical grafting strategies, as well as complete perioperative management, are considered as contributors to the improved outcomes.