No-Touch Aorta Off-Pump Coronary Bypass Operation: Arteriovenous Composite Grafts May Be Used as a Last Resort

Background. Off-pump coronary artery bypass (OPCAB) operations with bilateral internal thoracic artery (BITA) or left internal thoracic artery (LITA) and radial artery (RA) in a Y-graft configuration achieves adequate myocardial revascularization while avoiding manipulation of the ascending aorta. The purpose of our study was to determine if saphenous veins can be used as composite grafts with the LITA as a last resort. Methods. Multivessel OPCAB without aortic manipulation was performed in 564 patients between February 2002 and October 2010. Patients receiving a LITA-vein composite graft (n = 62) were older and had more emergency procedures, renal insufficiency, peripheral vascular disease and therefore a higher logistic Euro-SCORE predicted risk of mortality (all p < 0.001) than did patients who underwent BITA and LITA-RA grafts. Results. Overall 30-day mortality was 1.1%: 6.5% in patients who received LITA-vein grafts and 0.5% in both total arterial groups (p = 0.001). Neurologic events occurred in 3.2%, 0.7%, and 0.5% of patients, respectively (p = 0.3). No patient who received a LITA-vein graft experienced perioperative myocardial infarction (MI). Patients in the total arterial graft groups had better 5-year survival (> 90%) and freedom from major adverse cardiovascular and cerebrovascular events (>= 80%) than did patients who received LITA-vein grafts (74 +/- 7.8% and 62.5 +/- 8.1%, respectively). However there was no difference in the 3 groups with respect to freedom from MI and repeat revascularization. Conclusions. LITA-vein composite graft use is associated with a lower survival and higher complication rate, probably because of the higher patient risk profile. LITA-vein composite grafts may be used as a last resort in selected patients undergoing OPCAB operations without manipulation of the aorta when arterial grafts are not available or recommended. (Ann Thorac Surg 2013;95:846-53) (C) 2013 by The Society of Thoracic Surgeons