Comparison of off-pump and on-pump coronary endarterectomy for patients with diffusely diseased coronary arteries: early and midterm outcome

Journal of Cardiothoracic Surgery

Cui Zhang¹  Hongwei Shi¹  Fuhua Huang¹  Ming Xu¹  LiMing Wang¹  YingShou Jiang¹  Xin Chen¹  Zhibing Qiu¹ 

[1] Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, Nanjing, 210006, China

关键词: Left internal mammary artery;    Diffused coronary disease;    On-pump;    Off-pump;    Coronary endarterectomy;   

Others  :  1136121
DOI  :  10.1186/s13019-014-0186-5

 received in 2014-06-24, accepted in 2014-11-20,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Qiu et al.; licensee BioMed Central Ltd.

【 图 表 】

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