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J Thorac Cardiovasc Surg 2010;139:256-262
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Ten-year experience with off-pump coronary artery bypass grafting: Lessons learned from early postoperative angiography

Ki-Bong Kim, MD, PhDa,*, Jun Sung Kim, MDc, Hyun-Jae Kang, MD, PhDb, Bon-Kwon Koo, MD, PhDb, Hyo-Soo Kim, MD, PhDb, Byung-Hee Oh, MD, PhDb, Young-Bae Park, MD, PhDb

a Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
b Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
c Department of Thoracic and Cardiovascular Surgery, Boramae Medical Center, Seoul, Republic of Korea

Read at the Eighty-ninth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 9–13, 2009.

Received for publication April 30, 2009; revisions received August 15, 2009; accepted for publication August 26, 2009.

* Address for reprints: Ki-Bong Kim, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 28, Yeongeon-dong, Chongno-gu, Seoul 110-744, Korea. (Email: kimkb{at}snu.ac.kr).

Objective: We performed early postoperative angiography to assess anastomosis accuracy and patency after off-pump coronary artery bypass grafting.

Methods: One thousand three hundred forty-five patients who underwent off-pump coronary artery bypass grafting between January 1998 and December 2007 were studied. Grafts for distal anastomoses were left internal thoracic artery (n = 1281), right internal thoracic artery (n = 679), right gastroepiploic artery (n = 836), radial artery (n = 14), and saphenous vein (n = 188). Groups underwent off-pump coronary artery bypass grafting without (group I, n = 234) or with (group II, n = 1111) intraoperative graft flowmetry. Early postoperative (≤7 days) angiography was performed in 1278 cases (95.0%) at 1.6 ± 1.2 postoperative days.

Results: Operative mortality was 1.6%. Average number of distal anastomoses was 3.0 ± 1.0. Postoperative angiography showed early patencies of 98.9% for arterial grafts and 88.2% for venous grafts (P < .001). In group II, intraoperative flowmetry-guided revision was performed in 2.2% of distal anastomoses. Patency of arterial grafts was significantly higher in group II than group I (97.2% vs 99.1%, P < .001); however, patency of venous grafts was not significantly different (86.0% vs 92.2%, P = .099). Early reoperation for graft revision according to angiographic findings was performed in 35 patients.

Conclusions: Early patency of venous grafts was significantly lower than that of arterial grafts. Intraoperative flowmetry and revision of abnormal grafts improved early graft patency, and reoperation according to early angiographic findings may further improve graft patency.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; ITA = internal thoracic artery; LAD = left anterior descending coronary artery; OPCAB = off-pump coronary artery bypass grafting; RGEA = right gastroepiploic artery; TTFM = transit-time flow measurement






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