Complete revascularization is compromised in off-pump coronary artery bypass grafting.

OBJECTIVE: Patients who undergo off-pump coronary artery bypass grafting (OPCAB) commonly receive fewer bypass grafts and are more often incompletely revascularized compared with those receiving conventional coronary artery bypass (CCAB) recipients. Because this can compromise survival, we sought to determine whether patients undergoing OPCAB are incompletely revascularized and whether this affects long-term survival and freedom from cardiac events. METHODS: OPCAB cases (n = 411) performed from January 1, 1997 to June 30, 2003 were considered for inclusion and matching with 874 randomly selected, contemporary CCAB cases. After propensity matching, 308 OPCAB cases and 308 CCAB cases were included in the final analysis. We compared the number of bypass grafts and the completeness of revascularization by coronary territory. Survival and readmission for cardiac causes were monitored for up to 10 years postoperatively, with a median follow-up period of 5.9 years. RESULTS: On average, the patients undergoing OPCAB received significantly fewer distal anastomoses than did those undergoing CCAB (mean ± standard deviation, 2.6 ± 0.9 vs 3.0 ± 1.0, P < .0001). The circumflex territory was the most likely territory to be ungrafted during OPCAB in patients with angiographically significant obstruction (P = .0006). The frequency of complete revascularization was significantly different between the 2 groups (OPCAB, 79.2% vs CCAB, 88.3%; P = .0.002). The OPCAB group had a significantly greater rate of total arterial grafting (OPCAB, 66.6% vs CCAB, 49.7%; P = .0001). No difference was seen in 8-year survival or freedom from cardiac cause hospital readmission between the 2 groups. CONCLUSIONS: Despite receiving fewer distal anastomoses and the decreased frequency of complete revascularization, OPCAB and CCAB techniques produced comparable results.

Inferior vena cava division to access post-repair pulmonary venous obstruction.

Post-repair pulmonary venous obstruction is a complication that may occur after surgical repair of total anomalous pulmonary veins. Obstruction may occur at the site of surgical anastomosis or it may be intrinsic to the pulmonary veins. The optimal approach to post-repair pulmonary venous obstruction remains controversial because of high mortality rates and persistent risk of re-stenosis. We present a previously undescribed, inferior approach to anastomotic post-repair pulmonary venous obstruction. This approach allowed easy access and excellent visualization of the pulmonary confluence. Three years after the reoperation, the patient had a widely patent confluence-to-left atrial anastomosis.