Is off-pump coronary artery bypass surgery safe for left main coronary artery stenosis?

ABSTRACT

BACKGROUND: The feasibility of off-pump coronary artery bypass surgery has been well demonstrated. The purpose of the present study was to assess the safety and efficacy of off-pump coronary artery surgery in patients with left main coronary artery disease. METHODS AND RESULTS: Between January 1997 and December 2000, 174 patients with significant left main coronary artery stenosis underwent coronary artery bypass grafting without a pump. During the same period, 991 patients who also had significant left main coronary artery stenosis underwent coronary artery surgery on a pump. The patients in the two groups were matched in preoperative variables except that those in the off-pump group were slightly older, and more required urgent surgery. Hospital mortality was 2/174 and 21/991 in the off-pump and on-pump groups, respectively (p=0.560). The incidence of perioperative myocardial infarction (1.74 v. 14/991, p=0.712), atrial fibrillation (17/174 v 157/991, p=0.050) and blood transfusion requirement (63/174 v. 476/991, p=0.05) were significantly less in the off-pump group. The intubation time (15+/-3 hours v 22+/-4 hours, p=0.001), blood loss (365+/-61 ml v 582+/-76 ml, p<0.001), intensive care unit stay (23+/-10 hours v. 36+/-11 hours, p<0.001) and hospital stay (6+/-4 days v. 9+/-5 days, p <0.001) were also less in the off-pump group. CONCLUSIONS: Off-pump coronary artery bypass surgery is safe and effective for patients with left main coronary artery disease.