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. 2023 Sep;39(5):446-452.
doi: 10.1007/s12055-023-01526-3. Epub 2023 Jun 13.

Off-pump CABG surgery in left main coronary artery disease: a single-center prospective registry

Ajeet Bana  1 , Anuj Sangal  2   3 , Navneet Mehta  4 , Saurabh Jaiswal  5 , Sundeep Tirkey  6 , Vimal Kant Yadav  2 , Krishna Kumar Sharma  7 , Rajeev Gupta  8
Affiliations

Off-pump CABG surgery in left main coronary artery disease: a single-center prospective registry

Ajeet Bana et al. Indian J Thorac Cardiovasc Surg. 2023 Sep.

Abstract

Background and objective: The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Patients with left main multi-vessel coronary artery disease (LM CAD) have concerns regarding incomplete revascularization and reduced survival with off-pump (OPCAB) when compared with on-pump (ONCAB) coronary bypass surgery. To evaluate outcomes among high-risk LM CAD patients undergoing OPCAB, we performed a registry-based prospective study.

Methods: We performed 4868 coronary artery bypass graft (CABG) surgeries from Jan 2013 to Jun 2019 with 4662 (95.8%) OPCAB. In OPCAB cohort, we had 1323 patients (28.4%) with significant LM (> 50%) triple vessel CAD. Data regarding clinical features, extent of CAD, operative details, in-hospital outcomes, and 3-year follow-up were obtained. Descriptive statistics are reported.

Results: The study cohort (n = 1323) was aged 63 ± 9 years with men 88.4%. Tobacco use was in 328 (24.8%), diabetes 598 (45.2%), previous myocardial infarction 463 (35.0%), previous coronary intervention 40 (3.0%), and congestive heart failure in 54 (4.1%). All patients had LM (100.0%) with triple vessel disease in 99.4% (LAD, left anterior descending 100.0%; LCX, left circumflex 99.4%; RCA, right coronary artery 78.7%). Vessels bypassed/patient were 2.7 ± 0.4 with 3.2 ± 0.7 total grafts and 2.1 ± 0.8 venous grafts. In total, 1278 (96.5%) patients received left internal mammary artery (LIMA), 63(4.7%) bilateral internal mammary artery (BIMA), and 74 (5.6%) radial artery grafts. There was no patient with conversion from OPCAB to ONCAB. In-hospital major adverse cardiovascular events (MACE: all-cause deaths, myocardial infarction, and stroke) were in 21 (1.6%). At 3-year follow-up (n = 1041), MACE rates were in 84 (8.1%) and cardiovascular deaths in 28 (2.7%).

Conclusions: This study shows that off-pump CABG surgery is safe in patients with LM CAD. There is low in-hospital mortality and MACE and 3-year outcomes are similar to the published data of LM CAD patients who undergo on-pump CABG.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-023-01526-3.

Keywords: Coronary artery bypass surgery; CABG; Left main disease; Coronary revascularization; OPCAB.

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Conflict of interest statement

Conflict of interestThe authors have no conflict of interest.

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