Beating heart coronary artery bypass grafting: results from 402 patients and the usefulness of gastroepiploic artery composite grafting.

OBJECTIVES: We have studied the results of 402 consecutive cases of beating heart coronary artery bypass grafting (CABG) and evaluated the usefulness of gastroepiploic artery (GEA) composite grafts.

METHODS: Between March 1993 and August 2001, 402 patients underwent beating heart CABG. They were 321 male and 81 female patients, aged 17 to 88 (mean 66) years. Beating heart CABG was facilitated by mechanical stabilization with a doughnut stabilizer, a newly designed sternal retractor and a new coronary perfusion system. Minimally invasive direct coronary artery bypass (MIDCAB) was performed in 206 patients (the MIDCAB Group), and beating heart CABG with median sternotomy (OPCAB) was performed in 196 patients (the OPCAB Group).

RESULTS: Definite off-pump CABG was accomplished in 381 patients. 21 patients (5%) were converted to on-pump beating heart CABG using percutaneous cardiopulmonary system via femoral vessels because of hemodynamic instability. There was 1 operative mortality (0.2%). There was perioperative myocardial infarction in 2 (0.5%), and cerebral infarction in 3 (0.7%). The rate of complete revascularization was 78% in the MIDCAB Group and 97% in the OPCAB Group. The mean number of anastomoses was 1.6 in the MIDCAB Group and 3.3 in the OPCAB Group. The early graft patency was 99.1% in a left internal thoracic artery graft, 97.0% in a right internal thoracic artery graft, 96.5% in GEA, 98.2% in a radial artery graft, and 94.2% in a vein graft. A GEA composite graft was used in 55 of the 168 patients who received GEA grafting. The mean number of anastomoses for the GEA composite graft was 1.6 +/- 0.6 per patient. The graft patency rate was 94.6% (53/56) for GEA and 98.6% (72/73) for the radial artery used as a composite graft.

CONCLUSION: A consecutive series of beating heart CABG was performed safely and effectively with a low mortality rate and low morbidity rate. Beating heart CABG could be performed in all patients, and definite off-pump CABG was accomplished in 95% of them. In order to aim for complete revascularization, GEA composite graft was found to be effective since it required a low mean number of 1.6 anastomoses and a satisfactory patency rate at the same time.