Off-Pump Coronary Artery Grafting in Patients with Left Main Coronary Artery Disease

Abstract

Patients with LMCD can undergo OPCAB grafting safely and effectively despite reduced LVEF. LMCD should no longer be seen as a contraindication to perform OPCAB grafting.

Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies

“…Murzi et al (13) again showed this difference in practice; the OFP received fewer grafts and had a lower rate of complete revascularization. The same was evident in Virani et al (11) paper; the average number of grafts was 3.1 in OFP and 4.1 in ONP surgery (P=0.004).…”

“…Virani et al (11) found no difference in major complications i.e., stroke, myocardial infarction, renal failure, sternal wound infection between OFP and ONP. However, mean hospital length of stay favored the OFP.…”

“…The rates for OFP range between 0% to 1.8% and for ONP between 2.6% to 5% (Figure 1). The majority of these studies were not able to demonstrate a statistically significant difference (9)(10)(11)(12). Freedom from death at 30 days and 1 year has been shown 96.5% and 94.5% for the OFP group and 97.4% and 95.2% for the conventional ONP group, respectively (12).…”

“…Patients in the OFP routinely receive lower number of grafts compared to the ONP approach and even in some studies it is mentioned that the revascularization is incomplete, however the postoperative mortality is equal (10,11) or even favorable (13) when compared to conventional approach. This might indicate that the majority of the patients which had OFP surgery actually had less advanced disease or the incomplete revascularization might have involved less important coronary artery branches to achieve these results.…”

Off-pump coronary bypass grafting is safe and efficient in patients with left main disease and higher EuroScore☆

“…Similarly, Merharwal et al have found a similar outcome of OPCAB and on-pump surgery in patients with multi-vessel disease and overall higher risk [15]. Finally, Virani et al reported on the safety of OPCAB inpatients with LMD and reduced ejection fraction (EF) [16]. OPCAB practice is now widely accepted and expands further.…”