ABSTRACT 29

OFF-PUMP CORONARY ARTERY BYPASS MAY DECREASE THE PATENCY OF SAPHENOUS VEIN GRAFT

Ki-Bong Kim, Cheong Lim, Jeong Sang Lee, Hyuk Ahn, In-Ho Chae*, Byung-Hee Oh*, Myoung-Mook Lee*, Young-Bae Park*.

Dept. of Thoracic & Cardiovascular Surgery, *Dept. of Internal Medicine, Seoul National University Hospital, Seoul, Korea

Background;There is a concern that the procoagulant activity increases after coronary artery bypass grafting without cardiopulmonary bypass (OPCAB) and may potentially endanger the patency of anastomosis. The aims of this study were 1) to compare the one-year patency after OPCAB with that of conventional CABG and that of on-pump beating CABG, and 2) to demonstrate any differences in patency of coduits among three groups.

Methods; We analyzed the results of 122 consecutive OPCAB cases (group I), and compared with those of 65 consecutive conventional CABG cases (group II) and those of 19 consecutive on-pump beating CABG cases (group III).

Results; In group I, the average number of distal anastomosis was 3.1 ± 1.1. Postoperative angiography was performed in 111 (91%) patients before discharge and demonstrated 95.1 % (137/144) patency for internal thoracic artery (ITA), 85.9 % (159/185) patency for saphenous vein grafts (SVG). Radial artery (RA) (13/13) and right gastroepiploic artery (RGEA) (10/10) showed 100 % patency. One year follow-up angiography was performed in 86 patients (71 %), and demonstrated 93.5 % (101/108) patency for ITA, 65.6 % (101/154) patency for SVG. RA (8/8) and RGEA (7/7) showed 100 % patency.  In group II, the average number of distal anastomosis was 3.7 ± 0.9. One year follow-up angiography was performed in 41 patients (63 %), and demonstrated 92.9 % (39/42) patency for ITA, 88.0 % (95/108) patency for SVG. RA showed 100 % (2/2) patency. In group III, the average number of distal anastomosis was 3.6 ± 0.9. One year follow-up angiography was performed in 17 patients, and demonstrated 100 % patency for ITA (19/19) and RA (2/2), 86.8 % (33/38) patency for SVG.

Conclusion; Our results demonstrated that one-year patency of SVG after OPCAB was significantly lower than that of group II (p<0.001) and that of group III (p<0.01), although there was no significant differences in one-year patency of arterial grafts among three groups. Our data suggest that a specific perioperative anticoagulant therapy may be advisable in patients undergoing OPCAB with SVG.