Total Arterial Off-Pump Coronary Artery Bypass Grafting: A 10-Year Experience

Abstract

Background: Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting (CABG). We summarized our experience with total arterial off-pump coronary artery bypass grafting (OPCAB) and assessed the early clinical results, surgical complications, and follow-up.

Methods: From January 2007 to May 2017, 508 coronary artery disease patients undergoing total arterial OPCAB were enrolled. Clinical features, approaches, outcomes of surgical treatments, and follow-up data of these patients were studied retrospectively. A total of 122 patients underwent single left internal mammary artery (IMA)-left anterior descending artery grafts, whereas the other 386 patients underwent multiple vessel grafts.

Results: The average distal anastomosis was 2.34 ± 0.97 (range: 1-4). All the patients were discharged from hospital except one died. A total of 457 (90.32%) patients were followed up. In the 4-, 7-, and 10-year follow-up groups, the rate of death from any cause was 1.19%, 6.47%, and 10.67%; rate of cardiac death was 0.60%, 2.88%, and 3.33%; rate of repeat revascularization was 0.00%, 3.60%, and 8.67%; rate of ischemic symptoms was 1.79%, 7.91%, and 11.33%; and incidence of stroke was 2.38%, 4.32%, and 6.67%, respectively. Poor medication adherence was observed in 9.38% of the follow-up population.

Conclusions: Total arterial OPCAB with bilateral IMA, radial artery, and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group, without a significant increase in early mortality or morbidity. Moreover, the long-term outcomes are also positive.

Keywords: Coronary Artery Bypass Grafting; Gastroepiploic Artery; Off-Pump; Skeletonized Internal Mammary Artery; Total Arterial Revascularization.

Figure 1

Representative images of the off-pump coronary artery bypass grafting. (a) Classical three artery grafts in situ: skeletonized bilateral internal mammary arteries and right gastroepiploic artery. (b) Right gastroepiploic artery was grafted to the posterior descending artery.

Figure 2

Total arterial graft patency of the LIMA, RIMA, RA, and RGEA through CCTA or coronary angiography by the Kaplan–Meier method. LIMA: Left internal mammary artery; RIMA: Right internal mammary artery; RA: Radial artery; RGEA: Right gastroepiploic artery; CCTA: Coronary computed tomography angiography.