Korean J Thorac Cardiovasc Surg.
2000 Jan;33(1):38-44.
Off-Pump Coronary Artery Bypass Grafting
- Affiliations
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- 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine.
- 2Department of Anesthesiology, Seoul National University Hospital, Seoul National University College of Medicine.
Abstract
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BACKGROUND: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB)
performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial
ischemia during the aortic cross-clamp period.
MATERIAL AND METHOD: The preoperative diagnosis operative procedure mortality complication
and postoperative course of the 50 patients who underwent OPCAB between January 1998 and
September 1998 were analyzed. There were 34 males and 16 females with mean age of 60+/-9 years.
Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%)
and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and
postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were
three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%)
and left main disease in 13(26%) patients. There were elective operation in 37 cases and
urgent operation in 13 cases.
RESULT: The mean number of grafts was 3.2+/-1.2 per patient. Grafts used were unilateral
internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral
internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential
anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery
in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24
posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5
anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the
patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications
were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial
infarction in 2 femoral artery thromboembolism developed after the application of IABP in
1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen
patients(32%) were extubated at the operating room and the other patients were extubated at
the mean 13+/-20 hours after the operation. Mean duration of stay in intensive care unit was
49+/-46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the
amount of perioperative blood transfusion was mean 0.70+/-1.36 pack/patient.
CONCLUSIONS
OPCAB is suggested to be the ideal technique with less postoperative complication
less hospitalization time and less cost.