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J Thorac Cardiovasc Surg 2007;133:1499-1503
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Off-pump bypass of the left anterior descending coronary artery: 23- to 34-year follow-up

Department of Cardiovascular Surgery, Case Western Reserve School of Medicine, The University Hospitals of Cleveland, Cleveland, Ohio.

Received for publication November 9, 2006; revisions received January 23, 2007; accepted for publication January 29, 2007.

^_* Address for reprints: Jay L. Ankeney, MD, the Department of Cardiothoracic Surgery, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106. (Email: drankeney{at}aol.com).

Objective: We sought to develop a baseline for long-term survival of patients after off-pump bypass of the left anterior descending coronary artery with the heart beating.

Methods: We reviewed results for 241 consecutive patients with significant obstruction of the left anterior descending coronary artery who underwent surgery between November 1969 and the end of 1980. The off-pump operative technique involved elevating and stabilizing a segment of the distal left anterior descending coronary artery with 4 traction sutures. Starting in 1973, an internal thoracic artery became the graft of choice, so that a total of 171 patients received an internal thoracic artery bypass graft, and 70 patients received a saphenous vein graft.

Results: The median survival of patients with internal thoracic artery grafts was 23.7 years versus 17.9 years for patients with venous grafts (P < .02). Early patency of arterial grafts was 95%, and late patency was 90%. There were 2 (0.8%) operative deaths. Seventy of the 74 patients still alive in 2003 were interviewed by telephone, and 40 (57%) did not require additional invasive treatment, which is consistent with our finding that more than 50% of our patients after bypass of the left anterior descending coronary remained stable without obstruction of the right or circumflex arteries. However, atherosclerosis progressed in 30 (43%) of the survivors, who underwent reinterventions.

Conclusions: Off-pump bypass of the left anterior descending coronary artery with an internal thoracic artery can be done on a beating heart safely and results in median survival of patients for more than 23 years.