Introduction : The aim of this study is to determine the effectiveness and safety of Off Pump CABG (OPCAB) in the treatment of severe left main disease (LMD) associated (group1) or not associated (group 2) with a right coronary lesion .
Methods : From February 1999 to June 2001, among 331 consecutive patients having OPCAB, 58 patients (17,5%), 42 men and 16 women, had a severe LMD (>75% stenosis). Mean age was 67 years (36-86). Anastomoses were performed without shunting or ischemic preconditioning. LAD was the primary target in all 58 patients. A significant right coronary stenosis was seen in 32 patients (55%).
Results : In the study population with LMD, a mean of 2.7 anastomoses per patient was performed and bilateral mammary arteries were used in 33 patients (57 %). Hospital mortality was 3.4% (2 pts in group1) compared to 2.2% in the non-LMD population (Table 1). Four patients (6.9%) had to be converted to CPB for ischaemia or ventricular fibrillation in the LMD patients (1 in group1 and 3 in group2, NS). The overall conversion rate in the non-LMD population was 2.2%.
|
Table 1 |
Non -LMD |
LMD |
TOTAL |
| N (%) |
273 (82) |
58 (18) |
331 |
| Hospital mortality (%) |
6 (2.2) |
2 (3.4) |
8 (2.4) |
| Conversion to CPB ('%) |
6 (2.2) |
4 (6.9) |
10 (3.0) |
Operative morbidity was similar in both groups (Table 2)
| Table 2 |
Group 1 (CAD3) |
Group 2 (CAD2) |
| N (%) |
32 (55) |
26 (45) |
| Mortality |
2 |
0 |
| Conversion to CPB |
1 |
3 |
| Revision bleeding |
0 |
4 |
| Peroperative infarction |
1 |
0 |
Conclusion : Off pump myocardial revascularisation for severe left main disease is a safe and accurate procedure. The presence of an associated right coronary stenosis has no influence on the operative feasibility.