Immediate results of off-pump versus on-pump coronary artery bypass grafting using autoarterial conduits in situ and Y-graft configurations

Aim. To compare the immediate results of off-pump versus on-pump coronary artery bypass grafting (CABG) using autoarterial conduits.

Material and Methods. From January 2018 to September 2021, 178 coronary artery bypass grafting operations using autoarterial conduits were performed in the Department No. 1 of the Federal Center for Cardiovascular Surgery (Krasnoyarsk). The operation was performed on a beating heart in 88 patients (group 1) and using cardiopulmonary bypass in 90 patients (group 2). The majority of patients were males in both groups: 76 (86.3%) and 75 (83.3%) patients (p = 0.287). The patients were comparable in age (61.6 ± 7.7 and 60.2 ± 7.5 years, p = 0.237), body mass index (30.9 ± 5.7 and 29.8 ± 5, p = 0.18), and the presence of concomitant diabetes mellitus (30 (34%) and 19 (21.1%), p = 0.052). There were significantly more patients with hemodynamically significant lesions of the brachiocephalic arteries in group 1 (27 (30.7%) versus 13 (14.4%), p = 0.009) and calcification of the ascending aorta (24 (27.3%) versus 11 (12.2%), p = 0.011). The number of hemodynamically significant affected coronary arteries did not differ between the groups: 2.6 ± 0.7 versus 2.5 ± 0.5 (p = 0.393).

Results. Both internal thoracic arteries were used in situ or in the form of Y-grafts in both groups depending on the number of distal anastomoses. Hospital mortality was 2 patients (2.2%), both from group 2 (p = 0.161). The groups were comparable in the number of distal anastomoses (2.7 ± 0.7 and 2.7 ± 0.6, p = 0.532), the incidence of acute perioperative myocardial infarction (1 (1.1%) and 1 (1.1%), p = 0.987), neurological complications (1 (1.1%) and 2 (2.2%), p = 0.576), and bleeding requiring resternotomy (1 (1.1%) and 3 (3.3%), p = 0.325). Deep sternal wood infection was absent in both groups.

Conclusion. Autoarterial coronary artery bypass grafting is an effective method of myocardial revascularization in both the beating heart surgery and in cardiopulmonary bypass conditions. This method should be considered an operation of choice for patients with multiple coronary artery disease. The performance of operations in the conditions of cardiopulmonary bypass does not affect the increase in the number of cardiocerebral events in the postoperative period. 

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