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| Ten-Year Experience of Off-Pump Coronary Artery Bypass; Lessons Learned from Early Postoperative Angiograms | |
Ki-Bong Kim, Jun-Sung Kim, Hae-Young Lee, Hyun-Jae Kang, Bon-Kwon Koo, Hyo-Soo Kim, Dae-Won Sohn, Byung-Hee Oh, Young-Bae Park; Seoul National University Hospital, Seoul, Korea, South
Methods: One thousand and three hundred forty five patients who underwent OPCAB between January 1998 and December 2007 were studied. The grafts used for distal anastomoses were left internal thoracic artery (n = 1278), right internal thoracic artery (n = 677), right gastroepiploic artery (n = 837), radial artery (n = 14), and saphenous vein (n = 190). Early postoperative (1.8 ± 1.7 days) angiographies were performed in 1306 patients (97.1%). The patients were divided into group I (n = 234), which underwent OPCAB without using intraoperative graft flow measurement, and group II (n = 1111), which underwent OPCAB with flow measurement. Results: Operative mortality was 1.6%. The average number of distal anastomoses was 3.0 ± 1.0. Early postoperative patency rates were 98.8% (3554/3597) for arterial grafts and 88.2% (285/323) for vein graft (p = 0.00). In group II, intraoperative flowmeter-guided graft revision was performed in 2.6% (84/3239) of anastomoses. Patency rate of arterial grafts was significantly higher in group II than in group I (97.2%, 455/468 vs 99.0%, 3099/3129; p = 0.001); however, patency rates of vein graft was not different between the two groups (86.4%, 184/213 vs 91.8%, 101/110; p = ns). Early postoperative reoperation for graft revision was performed in 33 patients (6.4%, 15/234 in group I vs 1.6%, 18/1111 in group II; p = 0.001) based on the angiographic finding. Conclusion: The early postoperative patency rate of vein graft after OPCAB was significantly lower than that of arterial grafts. Intraoperative flow measurement significantly improved the patency rate of arterial grafts and decreased the reoperation rate for graft revision. There were 1.6% of patients requiring reoperation based on the early angiographic findings in spite of the intraoperative flowmeter-guided revision. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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