Total Arterial Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in Triple-Vessel Disease: Surgical Technique and Clinical Outcomes

Background This was a single-institutional study about total arterial off-pump coronary artery bypass graft surgery (OPCABG) using bilateral internal thoracic arteries in triple-vessel disease. Methods We retrospectively reviewed the records of 569 multivessel CABG patients (10% female) who underwent total arterial (bilateral internal thoracic arteries) OPCABG between January 2002 and December 2006. Mean age was 63.9 ± 8.9 years. All patients included underwent OPCABG as an elective procedure. Postoperative angiograms were evaluated during a postoperative follow-up period. Early and midterm outcomes, including overall patient survival, freedom from readmission and reintervention, freedom from the combined endpoint of cardiac events and quality of life, were evaluated. Multivariate analysis was used to find determinants of late death. Overall survival and freedom from combined endpoints were determined by the Kaplan-Meier method. Results The average number of distal anastomoses per patient was 3.18 ± 0.4. The average operation time was 209.7 ± 41.7 minutes. Thirty-day mortality was 0.88% (5 of 569). Overall patency rate for all grafts studies was 94.3% (632 of 670). Mean follow-up time was 810 days (range, 8 days to 61 months). Cumulative patient survival at 4 years was 93.3% ± 1.9%. Significant predictors of late mortality were age (hazard ratio, 1.06; 95% confidence interval: 1.01 to 1.12), previous stroke (hazard ratio, 6.5; 95% confidence interval: 1.8 to 23.5), and moderate to severe left ventricle ejection fraction (hazard ratio, 3.3; 95% confidence interval: 1.2 to 8.8). Freedom from hospital readmission and reintervention at 4 years was 91.7% ± 3.5%. Freedom from combined endpoint (death, hospital readmission, and reintervention) at 4 years was 86.9% ± 3.6%. There was a marked improvement in patientsʹ quality of life at follow-up (Duke Activity Status Index score > 45 in more than 70% patients). Conclusions Total arterial (bilateral internal thoracic arteries) OPCABG is feasible with a safe outcome in terms of hospital mortality. At follow-up the incidence of death, hospital readmission and reintervention and patientsʹ quality of life are acceptable with favorable graft patency rates.