ABSTRACT
The use of arterial conduits in CABG showed better results and higher patency in long term follow-up. Complete myocardial revascularization using only arterial conduits can be accomplished by using multiple arterial conduits with one directed to each distal site, or 3 arterial conduits with the use of sequential anastomoses. Finally, the advent of T- graft or Y- graft has allowed complete revascularization with only 2 conduits. In the last few years, off-pump CABG has progressed and showed more and more popularity. This technique allowed surgeons to operate on high risk groups with better patient outcome. The aim of this study is to assess our results with these new techniques. In addition, different techniques of myocardial protection have been used for comparison. The patient population consisted of 50 patients. Patients' profiles are explained in the text and in table 1. Inclusion criteria include the use of two or more arterial conduits and isolated coronary surgery. On the other hand, exclusion criteria include less than two arterial conduits or associated valvular surgery. We used different techniques of myocardial protection; warm intermittent blood cardioplegia in 14 patients [28 percent], crystalloid cardioplegia in 22 patients [44 percent], fibrillating heart with or without intermittent cross clamping in seven patients [14 percent] and OPCAB in seven patients. These patients were studied immediately after operation by hemodynamic monitoring, complete laboratory investigation, myocardial serum enzymes and daily ECG for 3 days. Three months later, these patients were studied by a complete clinical work-up, Echo and stress ECG. All the patients were stable hemodynamically. They were put on minimal vasopressor support and liberal use of nitroglycerine. Intraaortic balloon pumping was not used. We had few complications; two patients developed preoperative myocardial infarction [4 percent], and two others [4 percent] developed neurological problems, one of them died and this was the only mortality in this series [2 percent]. All techniques of myocardial protection used could be the same in some patients, but there are certainly some subsets of patients need special precautions. Chronic renal disease, elderly patients and redo CABG are better operated upon by off-pump CABG. Patients having bad left ventricular function may need warm blood cardioplegia for better myocardial protection. Therefore, every surgeon should be able to handle different techniques