1. Comparison of off-pump and on-pump coronary endarterectomy for patients with diffusely diseased coronary arteries: early and midterm outcome
- Author
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Liming Wang, Fuhua Huang, YingShou Jiang, Hong-Wei Shi, Cui Zhang, Ming Xu, Zhibing Qiu, and Xin Chen
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,China ,Coronary Artery Bypass, Off-Pump ,Off-pump ,Endarterectomy ,Anastomosis ,Severity of Illness Index ,On-pump ,Angina ,Postoperative Complications ,Diffused coronary disease ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Hospital Mortality ,Aged ,business.industry ,Coronary Stenosis ,General Medicine ,Perioperative ,Middle Aged ,medicine.disease ,Cardiac surgery ,Surgery ,Coronary arteries ,medicine.anatomical_structure ,Treatment Outcome ,Left internal mammary artery ,Cardiothoracic surgery ,Right coronary artery ,Cardiology ,Coronary endarterectomy ,Female ,Cardiology and Cardiovascular Medicine ,business ,Research Article - Abstract
Background Coronary endarterectomy (CE) is an alternative for the diffusely diseased left anterior descending (LAD), but its mid and long term results are largely questionable. This study is to compare the early to mid-term results between off-pump and on-pump coronary endarterectomy with coronary artery bypass grafting. Methods 212 consecutive patients underwent CE and bypass grafting for diffusely diseased LAD. Ninety-two patients undergoing CE with off-pump (group off-pump) were compared with 120 patients undergoing CE with on-pump (group on-pump). The main preference for selection to an off-pump CE surgery were the preoperative high risk factors, especially previous cerebrovascular accident、chronic obstructive pulmonary disease (COPD)、calcified ascending aorta and right coronary artery (RCA) critical stenosis >90%. Results There were three deaths in this group with total operative mortality of 1.4%. The perioperative mortality of group off-pump (1.1%) was similar with that of group on-pump (1.7%). The postoperative myocardial infarctions rate was 2.8%. There was no significant difference as for the morbidity between the group off-pump and group on-pump. Among survivors, the patency rate of the LIMA–LAD anastomosis was 89.4%. There was no difference as for the grafts patency rate between the two groups. Kaplan–Meier survival revealed no significant difference between the two groups. Kaplan-Meier freedom from cardiac events requiring hospital re-admission and angina recurrence were similar in both groups. Conclusions On-pump or off-pump CE is a good technique with the same early and mid-term outcomes. In the series of off-pump CE, we have shown that the effect of OPCABG with CE appears to be durable, and mid-term clinical outcomes are encouraging. Despite the higher risk profile, hospital mortality and major complications in our study are comparable to those for CCE. Electronic supplementary material The online version of this article (doi:10.1186/s13019-014-0186-5) contains supplementary material, which is available to authorized users.
- Published
- 2014