Early Outcomes Of Different Coronary Artery Bypass Grafting Surgical Methods In Patients With Significant Left Main Coronary Artery Disease

Objective: The aim of our study is to evaluate early outcomes of different coronary artery bypass grafting surgical methods in patients with significant left main coronary artery disease, and try to discuss the best surgical methods for patients with significant left main coronary artery disease.Methods : This retrospective study includes 165 patients with significant left main coronary artery disease accepted coronary artery bypass surgery in our hospital from January 2014 to June 2016. Patients were divided into three groups, 93 patients in off-pump coronary artery bypass grafting group, 35 patients in conventional on-pump group and 37 patients in on-pump beating heart group. Then preoperative, operative and postoperative variables were collected and evaluated among three groups of different surgical methods.Results: 1. Preoperative Variables. In all, 165 patients with significant left main coronary artery disease underwent coronary artery bypass grafting, patients’ mean age was 60.59±8.15(39-76)years, male 116(70.30%),female 49(29.70%). Preoperative patient characteristics revealed no significant differences between three groups include sex, smoker, diabetes, hypertension, hypercholesterolemia, chronic renal failure, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular accident, congestive heart failure, CCS class, NYHA class, arrhythmias, PCI history and preoperative biochemical test results. But CCABG group mean age was younger than OPCABG group and ONPBH group(P<0.05). History of myocardial infarction, ONPBH group was higher than OPCABG group and CCABG group. Left ventricle end-diastolic diameter, ONPBH group was longer than OPCABG group and CCABG group(P<0.05). Left ventricular ejection fraction, ONPBH group was lower than OPCABG group and CCABG group(P<0.05), there was no difference between OPCABG group and CCABG group(P=0.931).2. The number of grafts performed per patient of CCABG group was less than OPCABG group and ONPBH group(P < 0.05). Red blood cell transfusion of OPCABG group was less than CCABG group and ONPBH group(P < 0.05). Intra-aortic balloon pump usage of ONPBH group was higher than OPCABG group and CCABG group(P<0.05). Numbers of artery anastomosis of CCABG group was more than OPCABG group and ONPBH group(P<0.05), About bypass conduits, great saphenous vein usage of ONPBH group was more than OPCABG group and OPCABG group was more than CCABG group. Left internal mammary artery usage was similar among three groups. There were 8 patients(22.6%) have radial artery as bypass conduit only in CCABG group. Other bypass conduits were right internal mammary arteries(OPCABG group 1 cases(1.1%) vs CCABG group 5 cases(14.3%)) were significantly different(P=0.001). Index of completeness of revascularization was similar among three groups.3. Postoperative Data. Time to extubation of OPCABG group was shorter than CCABG group and ONPBH group. ICU stay time of ONPBH group was longer than OPCABG group and CCABG group(P<0.05). Volume of total drainage of OPCABG group was less than CCABG group(P=0.01) and CCABG group was less than ONPBH group(P=0.004). Postoperative red blood cell transfusion of OPCABG group was less than CCABG group(P=0.024) and CCABG group was less than ONPBH group(P<0.05). Postoperative plasma transfusion of ONPBH group was more than OPCABG group(P=0.024) and CCABG group(P<0.05). Postoperative hospital stay of OPCABG group was shorter than CCABG group and On PBH group. Total IABP insertion, ONPBH group have more IABP inserted than OPCABG group and CCABG group(P<0.0167). OPCABG group have less cases of ventilation time over 24 h than ONPBH group and CCABG group(P<0.0167). Perioperative AMI, new atrial fibrillation and in-hospital mortality were similar among three groups. CCABG group have more cases of AKI than OPCABG group(P=0.013).4. Biochemical Data. OPCABG group, CCABG group and ONPBH group had a similar tendency of serum c Tn I level, preoperative baseline were similar(P>0.05). Serum c Tn I level was significant higher than baseline 1 hour after surgery(P<0.05) and peaked in 1 day, CCABG group was higher than On PBH group(P<0.05), ONPBH group was higher than OPCABG group(P<0.05). It back to normal after surgery 3~5 days. Serum creatinine level was similar before surgery(P>0.05) and was significant higher than baseline 1 day after surgery(P<0.05), CCABG group was higher than ONPBH group(P<0.05). Serum creatinine level reached a peak in 1 day later(OPCABG group, peak level 86.53±29.80μmol/L), 2~3 days later(CCABG group, peak level 89.77±18.34μmol/L) and(ONPBH group, peak level 124.17±62.34μmol/L) separately, then back to normal 5~7days later.Conclusions: 1. Off pump coronary artery bypass grafting is a safe and effective surgical option in patients with significant left main coronary artery disease;2. Conventional coronary artery bypass grafting is the preferred method of total arterial coronary artery bypass grafting for patients with significant left main coronary artery disease.3. On pump beating-heart coronary artery bypass grafting seems to be advantageous in risk patients with hisroty of myocardial infarction, left ventricular dilation and low left ventricular ejection fraction.