RESUMO
Objective Off-pump coronary artery bypass grafting (OPCAB) is used more widely in recent years in China. However, there is an argument on benefits and risks of off-pump surgery. Many studies shown that OPCAB had more benefits in short-term outcomes than conventional coronary artery bypass grafting(CCABG). But evidences from other studies suggested that OPCAB resulted in less long-term graft patency as compared with on-pump surgery. This study examined the longterm graft patency of OPCAB and CCABG performed by one surgeon. Methods 50 patients who had received surgical revascularization by a surgeon for more than 5 years were reviewed, 25 patients received conventional coronary artery bypass grafting ( group 1 ) and 25 patients received OPCAB ( group 2). All patients had angiograms for compareing the graft patency between the two groups. Results Among 25 patients in group 1,21 were male and 4 were female. The mean age of patients at surgery was (55.4 ±8.9) years. 15 cases had unstable angina, 16 patients had old myocardial infarction and 6 cases had diabetes.The ejection fraction (EF) was 0.58 ±0.14. The mean number of bypasses per patient was 3.32 ±0.63. Mean duration of operation was (3.58 ± 0. 82) hours. Mean follow-up duration was ( 86.52 ± 12.48) months. 83 grafts were evaluated for patency ( open vs. closed) and were graded by Fitzgibbon as grade A ( excellent graft), B ( impaired graft, with a stenosis of ≥50%, or a diameter less than 50% of the grafted artery), or O ( completely occluded). The graft patency was 73.49%, 61grafts were graded as Fitzgibbon A, 6 grafts as Fitzgibbon B and 16 grafts as Fitzgibbon 0. 25 patients were in group 2, 21males and 4 females. The mean age of patients at procedure was (58.2 ± 9.09) years, 11 patients had unstable angina, 13 patients had old myocardial infarction and 6 cases had diabetes. The ejection fraction (EF) was 0.59 ± 0. 14. Conclusion No 2011.03.013 difference in long-term graft patency was identified between on-pump and off-pump coronary artery bypass grafting. Off-pump oronary artery bypass grafting preformed by an experienced surgeon may gain similar long-term graft patency to that of conventional bypass.
RESUMO
Objective: To study the efficacy and clinical experience of surgical treatment in the patients with left main coronary artery stenosis. Methods: Two hundred and twenty-five patients with left main stenosis (LMS) underwent coronary artery bypass graft (CABG) between January 1999 and June 2003. The average age was 63.4 years. The left ventricular ejection fraction was ≤30% in 11 patients. Emergency surgical revascularization was performed in 6 patients because of hemodynamic instability in whom 3 were treated with intraaortic balloon pump (IABP) before surgery. Seventy-six patients underwent coronary artery revascularization with conventional cardiopulmonary bypass, 149 without pump (OPCAB), and 5 patients were converted to CPB. Thirteen patients accepted total arterial revascularization and 3 total venous conduits. Results: The mean preoperative stay was 2.3 days and number of distal anastomoses was 2.95/pt. There were 13 postoperative deaths with a mortality of 5.78%. Conclusion: The presence of left main stenosis is an independent predictor of postoperative mortality after coronary bypass grafting. CABG at presents is the first choice for such patient and is a safe and effective method.