Early and late outcome after off-pump coronary artery bypass graft surgery with coronary endarterectomy: A single-center 10-year experience

Background. We aimed to review the early and late results of off- pump coronary artery bypass graft surgery ( OPCABG) with coronary endarterectomy in patients undergoing surgical revascularization at our institution. Methods. Between 1995 and 2004, of 680 OPCABG patients in a single surgeon's practice ( W. R. D.), 70 patients ( 10.29%) who underwent concomitant coronary endarterectomy were studied. The mean age was 63.6 +/- 9.29 years. Thirty- three patients ( 55%) were Canadian Cardiovascular Society class III or IV, and 24 patients ( 40%) were New York Heart Association class III or IV. Eighteen patients ( 35%) had impaired left ventricular function. The mean EuroSCORE of these patients was 5.9 +/- 1.8. Results. Fifty- seven patients ( 81%) underwent right coronary artery endarterectomy, and 12 patients ( 17%) underwent left anterior descending artery endarterectomy ( 8 left interior mammary arteries used as conduits). Four patients ( 5.7%) had two vessels endarterectomized. The mean number of grafts were 2.0 +/- 0.4. The 30- day mortality rate was 2.85% ( n = 2). Three patients ( 4.3%) suffered from postoperative myocardial infarction, and 3 patients ( 4.3%) required postoperative intra- aortic balloon pump counterpulsation. Mean intensive therapy unit stay was 17.6 +/- 8.1 hours. Patients were extubated after a mean of 10.38 +/- 4.9 hours. The mean length of hospital stay was 6.1 +/- 2.0 days. Fourteen patients ( 20%) had postoperative atrial fibrillation, and only 1 patient ( 1.42%) had a transient stroke with complete recovery. There were no conversions to cardiopulmonary bypass. A mean of 0.86 +/- 0.17 units of blood were transfused postoperatively. There was one reopening for bleeding, and 1 patient had renal failure requiring hemofiltration. The median follow- up was 4.91 years, 90% of patients were angina free, and the actuarial survival at 10 years was 78.04% +/- 7.6%. Conclusions. Off- pump coronary artery bypass graft survery with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse coronary artery disease.