体外和非体外循环对冠状动脉搭桥术疗效的影响

目的 :对比分析 63例非体外循环冠状动脉搭桥术 (OPCAB)和 87例常规体外循环下冠状动脉搭桥术 (CCABG)的疗效。方法 :对 15 0例冠状动脉搭桥术的疗效进行回顾性分析。结果 :两组均无手术死亡 ;OPCAB组在ICU时间、呼吸机辅助呼吸时间方面优于CCABG组 ;但两组术后均无心绞痛复发。结论 :OPCAB和CCABG均安全可行 ,疗效确实 ;OP CAB与CCABG相比 ,虽有一定优势 ,但不能取代CCABG。     

常规与非体外循环冠状动脉旁路移植术治疗冠状动脉多支病变的对比分析

目的　评价非体外循环下冠状动脉旁路移植术 (OPCAB)与常规体外循环下冠状动脉旁路移植术(CCABG)相比是否具有优越性。　方法　将 170例 2支以上血管病变行冠状动脉旁路移植术 (不包括瓣膜手术或室壁瘤切除等合并手术的病例 )患者分为 OPCAB组和 CCABG组 ,OPCAB组通过胸骨正中切口 ,在非体外循环心脏不停跳下完成冠状动脉旁路移植术 ;CCABG组建立常规体外循环 ,心脏停搏下完成冠状动脉旁路移植术。对两组病例的术前和术后各项指标进行对比分析。　结果　两组患者术前的一般情况无差异 ,OPCAB组与 CCABG组间曾行溶栓或经皮腔内冠状动脉成形术治疗和 3支病变的比例分别为 31.8%比 18.3%和 5 9%比 78% ,移植旁路血管分别为3.6± 0 .8支比 4.3± 1.0支 (P<0 .0 1) ,但所用的血管材料两组间无差异。OPCAB组术后呼吸机辅助时间和外科住院时间较短 ,住院费用较低 (P<0 .0 5 )。但术后并发症如二次开胸止血、伤口感染、心律失常、围术期心肌梗死、肺部并发症等的发生率 OPCAB组为 9.8% ,CCABG组为 14.6 % ;OPCAB组无手术死亡 ,CCABG组死亡 1例 (P>0 .0 5 )。　结论　 OPCAB治疗冠心病多支病变的初期结果显示可以减少患者术后辅助呼吸时间和外科住院时间 ,降低住院费用。但目前尚不能替代 CCABG,其近、远期效果仍     

非体外循环冠状动脉搭桥术术后早期心脏功能评价

目的 评价非体外循环冠状动脉搭桥术（OPCAB）术后早期心脏功能。方法 OPCAB组42例，体外循环冠脉搭桥术组63例（对照组），对比两组血浆心肌酶水平和心电图变化，利用Wwan-Ganz导管分析术中和术后血液动力学变化趋势，并评价早期临床效果。结果 两组临床资料无差别。OPCAB组中CK、CK－MB、AST、LDH的平均血浓度在术后当天、术后1d、3d和术后1周均正常，而对照组则有升高。OPCAB组心电图阳性变化数目较对照组少见。血液动力学指标显示，OPCAB组的心排指数、每搏输出量指数和左室作功能指数匀较对照组恢复迅速，而肺动脉楔压和中心静脉压水平偏低。OPCAB组近期临床效果也较对照组优越。结论 OPCAB组术后早期心脏功能优于体外循环下的冠状动脉搭桥术，提示OPCAB手术心肌保护效果好，血管吻合的精确性也令人满意。     

非体外循环冠状动脉旁路移植术的临床应用

目的　总结 36例冠状动脉粥样硬化性心脏病患者在非体外循环下行冠状动脉旁路移植术 (OPCAB)的临床经验。　方法　采用胸骨正中切口 ,应用心脏表面固定器、头低脚高位、心包深部放置牵引线、冠状动脉内置入分流器和吹雾器行 OPCAB。　结果　所有患者均使用左乳内动脉 (L IMA) ,移植血管 1～ 4根 ,平均 2 .6根 ;平均手术时间 16 1分钟 ;术中平均失血 32 0 ml。 1例在术中改为常规体外循环冠状动脉旁路移植术。术后 2 4小时平均引流量 380ml,平均输血或血液制品 32 0 ml。4例患者手术后在手术室内拔除气管内插管 ,ICU平均机械辅助通气时间 4.2小时 ;ICU平均监护时间 12 .6小时 ,术后平均住院时间 12 .5天。 1例术后 14天死于严重的肺部感染。术后随访 1～ 7个月 ,所有存活患者心绞痛症状消失。　结论　OPCAB创伤小、安全、经济、临床效果好 ,适用于单支、多支冠状动脉病变和具有高危因素的患者。     

体外循环及非体外循环对冠状动脉搭桥术患者围手术期炎症反应及疼痛的影响

目的 探讨体外循环及非体外循环对冠状动脉搭桥术患者围手术期炎症反应及疼痛的影响。方法 收集2018年12月至2021年12月于泰州市人民医院与上海交通大学医学院附属第一人民医院行冠状动脉搭桥术（CABG）的150例患者的临床资料,按照其接受术式的不同分为非体外组[n=78,采用非体外循环冠状动脉搭桥术（off-pump coronary artery bypass surgery,OPCAB）]与体外组（n=72,采用CABG）。比较两组患者的手术指标,包括血管桥数、气管插管时间、手术时间、住院时间、住院费用。术前、术后3 d、术后7 d比较两组患者的炎症因子水平,包括肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)。术前、术后12 h、术后24 h,比较两组患者的视觉模拟评分法（VAS）评分。术前、术后7 d、术后3个月评估两组患者心功能指标,包括左心室舒张末期内径（LVEDD）和左心射血分数（LVEF）。统计两组患者术后近期不良反应发生情况,包括心律失常、肾功能不全、神经系统症状、肺不张。结果 非体外组患者气管插管时间、手术时间、住院时间和住院费用均低于体外组患者（P&l...     

OPCAB患者术后监护期间实施临床路径探讨

目的探讨非体外循环冠脉搭桥术（（）PCAB）患者术后监护期间实施临床路径（CP）的效果。方法将64例OPCAB患者随机分为对照组（34例）和观察组（30例）。对照组实施常规护理，观察组实施临床路径管理，比较两组术后一般情况、术后并发症发生情况、入住ICU时间、术后住院时间及住院费用等。结果观察组术后首次下床活动时间和首次排便时间明显早于对照组（t=8．213、4．032，P〈0．01）；观察组患者术后住院时间显著短于对照组（t=2．741，P〈0．01）．住院费用明显低于对照组（t=2．063，P〈0．05）。结论临床路径为OPCAB术后监护期间患者的治疗护理提供了标准化模式，能显著促进患者术后康复进程，提高医疗护理质量。     

体外与非体外循环冠状动脉旁路移植术治疗高危冠心病患者的对比分析

目的对比分析体外循环冠状动脉旁路移植术（CABG）和非体外循环冠状动脉旁路移植术（OPCAB）治疗高危冠心病患者的手术效果，并总结其临床经验。方法将欧洲心脏手术风险评估系统（EuroSCORE）≥6分的210例高危冠心病患者，根据采用的术式不同分为两组，CABG组：90例，在体外循环下行CABG；OPCAB组：120例，行OPCAB。比较两组患者的手术死亡率、二次开胸止血、肾功能损害、再血管化指数、移植血管血流量、呼吸机支持时间、胸腔引流量和输血量等。结果两组各死亡1例，分别死于恶性室性心律失常和严重低心排血量综合征，两组在死亡率、冠状动脉内膜剥脱率、心房颤动发生率、脑梗死发生率、二次开胸止血、再血管化指数、移植血管血流量等方面差异无统计学意义（P〉0．05）；而OPCAB组患者的肾功能损害（Cr〉100μmol／L）、呼吸机支持时间、胸腔引流量和输血量均少于或低于CABG组（P〈0．05）。结论OPCAB适用于高危冠心病患者，而且在缩短呼吸机支持时间、减少胸腔引流量、输血量和减轻肾功能损害等方面具有一定的优势。     

OPCAB患者术后监护期间实施临床路径探讨

目的探讨非体外循环冠脉搭桥术(OPCAB)患者术后监护期间实施临床路径(CP)的效果。方法将64例OPCAB患者随机分为对照组(34例)和观察组(30例)。对照组实施常规护理,观察组实施临床路径管理,比较两组术后一般情况、术后并发症发生情况、入住ICU时间、术后住院时间及住院费用等。结果观察组术后首次下床活动时间和首次排便时间明显早于对照组(t=8.213、4.032,P<0.01);观察组患者术后住院时间显著短于对照组(t=2.741,P<0.01),住院费用明显低于对照组(t=2.063,P<0.05)。结论临床路径为OPCAB术后监护期间患者的治疗护理提供了标准化模式,能显著促进患者术后康复进程,提高医疗护理质量。     

EuroSCORE高危患者行心脏不停跳冠状动脉旁路移植术的获益

目的对比分析体外循环冠状动脉旁路移植术（CABG）和非体外循环冠状动脉旁路移植术（OPCAB）在治疗根据欧洲心脏手术风险评估系统（EuroSCORE）划分的高风险冠状动脉粥样硬化性心脏病（冠心病）患者的手术获益,并总结其临床经验。方法 2007年6月至2013年7月安徽医科大学附属省立医院心脏外科共收治经冠状动脉造影检查确诊的211例冠心病患者,在初次择期手术的冠心病患者中,将同期伴有瓣膜、左心室或主要血管手术的患者剔除。其中52例患者行CABG,男39例、女13例,年龄（61.5±6.5）岁,159例患者行OPCAB,男104例、女55例,年龄（63.9±7.2）岁。根据EuroSCORE计算每例患者的手术死亡率的预测风险（PROM）分值,PROM≥6的患者进入高风险组。比较OPCAB和CABG患者的手术死亡率、手术时间、术后胸腔引流量与输血量、血管吻合的支数、住重症监护室（ICU）时间、呼吸机辅助时间、术后肾功能不全发生率以及高风险组的30 d心血管事件（心律失常、心源性休克）、术后心绞痛、卒中的发生率。结果 OPCAB组和CABG组患者的左主干病变相似,其中OPCAB组血管吻合的支数（2.75±0.82）支,CABG组血管吻合的支数（2.83±0.58）支,两组差异无统计学意义（P〉0.05）。OPCAB组与CABG组在手术时间[（3.92±0.79）h vs.（6.83±1.53）h]、胸腔引流量[（983.14±802.39）ml vs.（1 620.40±879.32）ml]、输血量[（1 289.30±668.08）ml vs.（2 325.30±491.98）ml]、住ICU时间[（3.90±1.33）d vs.（5.08±1.78）d]、呼吸机辅助时间[（9.63±3.32）h vs.（13.76±3.79）h]差异均有统计学意义（P〈0.05）,OPCAB组30 d死亡率与CABG组差异无统计学意义（1.26%vs.3.85%,P〉0.05）。高风险子组中的患者,30 d卒中发生率CABG相比较OPCAB的比值比（OR）为5.7（95%CI 1.28～25.09,P〈0.05）,30 d心血管事件和术后心绞痛的发生率两组相似。结论 OPCAB与CABG在生存率和血管吻合数方面差异无统计学意义。而相对于CABG,OPCAB在手术时间、胸腔引流量与输血量及住ICU时间、呼吸机辅助时间上都具有优势。在基于EuroSCORE评分的高危患者中,OPCAB相对于CABG更有利于短期卒中预防。     

非体外循环冠状动脉搭桥术的近期疗效评价

目的　分析非体外循环 (OPCAB)与常规体外循环下冠状动脉搭桥术 (cCABG)后监护特点和近期疗效。　方法　比较OPCAB组 (6 0例 )和cCABG组 (6 2例 )术后引流量和输血量、血管活性药物的使用、一般监护治疗和恢复情况及近期临床疗效。　结果　OPCAB组术后引流量小于 4 0 0ml的例数明显多于cCABG组 (χ2 =7.316 ,P <0 .0 1) ,而大于 80 0ml的例数明显少于cCABG组 (χ2 =13.2 16 ,P <0 0 0 1)。OPCAB组术后未输血例数明显多于cCABG组 (χ2 =37.793,P <0 0 0 1)。OPCAB组使用硝普钠的例数较cCABG组多 (χ2 =12 .0 0 6 ,P <0 .0 0 1) ,而使用多巴胺的例数明显少于cCABG组 (χ2 =32 .198,P<0 .0 0 1) ,且未使用多巴酚丁胺。OPCAB组术后辅助通气 (5 .9± 3.3)h ,心电监测 (4.8± 1.7)d ,术后(18 1± 4 .1)h坐起 ,(15 .2± 5 .0 )h开始进食 ,平均 (2 .3± 0 .9)d拔除引流管 ,均明显短于cCABG组 (t =14 .0 2 5 ,5 .4 71,5 .791,8.95 3,5 .80 0 ,P <0 .0 1)。OPCAB组死亡 1例 ,围术期心肌梗死 1例 ,心律失常 4例 ,使用IABP 1例 ,较cCABG组少 ,但差别均无显著性 (χ2 =1.776 ,1.776 ,1.937,1.77,P >0 .0 5 )。　结论　OPCAB术后循环稳定 ,创伤小 ,恢复快 ,体现出微创手术的优越性     

常规与非体外循环下冠状动脉3支病变旁路移植血管通畅性对比分析

目的　评价非体外循环下冠状动脉旁路移植术 (OPCAB)与体外循环下冠状动脉旁路移植术 (CCABG)治疗冠状动脉三支病变术中旁路早期通畅性。方法　 6 0例 3支血管病变的病人分为OPCAB组和CCABG组 ,每组各 30例。行冠状动脉旁路移植术 ,OPCAB组胸骨正中切口 ,在非体外循环心脏不停跳下完成手术 ;CCABG组建立常规体外循环 ,心脏停跳下完成手术。术中应用即时血流测量技术对旁路血管进行流量测量。对比分析两组术前、术后的各项指标及各血管旁路流量、搏动指数和血流波形。结果　两组病人术前一般情况差异无统计学意义。OPCAB组与CCABG组移植旁路血管分别为 (3 6±0 6 )支与 (4 3± 0 9)支 (P <0 0 1) ;两组前降支及右冠状动脉旁路血流量、搏动指数差异无显著性。CCABG组回旋支序贯旁路和远端吻合口多 ,血流量较OPCAB组高。两组弥漫病变血管旁路血流量小。结论　OPCAB与CCABG治疗 3支病变 ,两组血管旁路早期通畅性差异无显著性。     

70岁以上患者不停跳冠状动脉搭桥术的临床分析

目的　探讨 70岁以上患者冠状动脉外科治疗的术式选择及不停跳搭桥术的安全性。方法　选择我科 1997年 9月至 2 0 0 3年 2月完成的≥ 70岁行不停跳搭桥术治疗患者 6 3例 ,分别与同期同一年龄组行单纯常规搭桥术的 94例患者及同期 <70岁行不停跳搭桥术的 5 8例患者进行比较、分析。结果　在术后正性肌力药物的使用率 (12例、19%与 34例、36 % )、输血率 (47例、75 %与 81例、86 % )、二次开胸率 (0例、0与 4例、4 % )、辅助呼吸时间 [(8± 6 )h与 (16± 12 )h]、院内病死率 (1例、2 %与 4例、4 % )等方面 ,≥ 70岁患者的不停跳搭桥术均优于常规搭桥术 ;≥ 70岁与 <70岁患者不停跳搭桥的术后并发症发生率 (19%与 19% )及院内病死率 (1例、2 %与 1例、2 % )差异无显著意义。结论　与行常规冠状动脉搭桥术的患者相比 ,高龄患者进行不停跳搭桥术有明显的优越性。对高龄患者行不停跳搭桥术 ,安全、临床效果确切     

体外循环与非体外循环下冠脉搭桥术患者术中血液动力学的比较

目的比较体外循环(CPB)与非CPB下冠脉搭桥术患者术中血液动力学的变化。方法同期行CPB下冠状动脉搭桥术(CABG)与非CPB下冠状动脉搭桥术(OPCAB)患者各70例,分别为CABG组和OPCAB组,分别在麻醉诱导后手术开始前(术前)和术毕用Swan-Ganz导管监测血液动力学指标。结果与术前比较,两组术毕心率(HR)、平均动脉压(MAP)、肺动脉平均压(PAMP)、肺毛细血管嵌压(PAWP)、中心静脉压(CVP)及左室作功指数(LVSWI)差异无统计学意义(P>0.05),心输出量(CO)、心脏指数(CI)均升高;OPCAB组术毕心搏指数(SVI)升高,体循环阻力指数(SVRI)、肺循环阻力指数(PVRI)降低(P<0.05),CABG组术毕SVI、SVRI、PVRI差异无统计学意义(P>0.05);与CABG组比较,OPCAB组术毕SVRI、PVRI降低(P<0.05)。结论两组患者术后心功能均得到了改善,OPCAB 组在改善心功能、降低体、肺循环阻力方面,优于CABG组。     

Off-pump coronary artery bypass grafting: initial experience at one community hospital

BACKGROUND: This study reports one cardiac surgical center's experience with off-pump coronary artery bypass (OPCAB) and compares clinical risk factors and outcomes with a group of patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass at the same institution. METHODS: Data on preoperative risk factors, intraoperative clinical markers, and postoperative outcomes were collected prospectively on all patients undergoing cardiac surgical procedures at our institution. From January 1, 1999, through October 7, 1999, 332 patients underwent OPCAB procedures at our institution. This group was compared with 445 consecutive patients undergoing CABG at the same institution during the period of January 1, 1998, through November 30, 1998. RESULTS: The two groups were similar with respect to preoperative clinical risk factors. Intraoperative data showed OPCAB patients tended to have fewer grafts performed and had a lower frequency of multiple grafts to obtuse marginal vessels. Outcomes showed no differences in the incidence of perioperative stroke, mediastinitis, reexploration for bleeding, pulmonary complications, new renal failure, postoperative atrial fibrillation, or transfusion of blood products. Patients in the OPCAB group had fewer perioperative myocardial infarctions and lower incidence of postoperative low cardiac output syndrome. A higher percentage of OPCAB patients had surgical lengths of stay of 5 days or less. The OPCAB group tended to have a lower in-hospital mortality rate but this difference did not reach statistical significance. CONCLUSIONS: Off-pump coronary artery bypass grafting with revascularization of all coronary artery segments is a safe and effective procedure that can be performed with equal or improved outcomes and shorter surgical lengths of stay compared with CABG with cardiopulmonary bypass.     

70岁以上患者冠状动脉旁路移植术

目的 总结70岁以上患者冠状动脉旁路移植术的经验,就伴发疾病的处理、手术适应证、手术技术及效果进行分析. 方法 2004年3月至2008年3月,采用冠状动脉旁路移植术治疗70岁以上高龄患者91例,年龄70～83岁.75岁以上者22例.心肺转流冠状动脉旁路移植组(CCABG组)72例,非体外循环冠状动脉旁路移植组(OPCAB组)19例.两组术前临床资料无明显差异.其中CCABG组术前植入颈动脉支架2例,肾动脉支架2例;OPCAB组植入颈动脉支架2例,肾动脉支架1例.全组左侧胸廓内动脉使用率为96.7%;CCABG组心肺转流时间(108±34)min;主动脉阻断时间(70±22)min;搭桥数(3.5±0.8)支.OPCAB组搭桥数(2.9±0.7)支. 结果 全组住院死亡2例,均为慢性阻塞性肺疾病合并肺感染.CCABG组有1例脑梗死,2例肺部感染,但与OPCAB组相比差异无统计学意义.两组在呼吸机辅助时间、ICU时间、呼吸衰竭、急性肾功能衰竭、二次开胸等方面无明显差异.但CCABG组搭桥支数高于OPCAB组(P<0.01).术后随访3～36个月,OPCAB组1例复发心绞痛,药物控制有效. 结论 处理好伴发疾病,充分再血管化,最大限度改善心肌供血,70岁以上CABG患者也可以取得满意疗效.是否在心肺转流下手术,预后并无明显差异.     

Change in the volume of extra cellular fluid in coronary artery bypass grafting (CABG); comparison between off-pump and on-pump CABG

During the perioperative period for off-pump coronary artery bypass surgery (OPCAB) and on-pump coronary artery bypass surgery (on-pump CABG), the volume of extra cellular fluid (ECF) was measured. The subjects were elective adult coronary artery bypass surgery cases, consisting of 13 OPCAB cases and 7 on-pump CABG cases. The ECF volume was measured the day before surgery, immediately after surgery, and 2, 4, 6, 8, 12, 24 and 48 hours after surgery, with a bioimpedance analyzer (XITRON 4000 C). ECF volume variation was defined as the difference from the preoperative value divided by body weight, and was expressed in %BW. At the same time, respiratory-index and leukocyte count were measured. The maximum postoperative ECF volume was 3.13 +/- 2.6 %BW in the OPCAB group and 5.36 +/- 2.0 %BW in the on-pump CABG group, that is, significantly higher in the on-pump CABG group. The ECF volume started to increase in the on-pump CABG group immediately after surgery (4.38 +/- 1.8 %BW in the on-pump CABG group and 2.07 +/- 2.4 %BW in the OPCAB group), reaching its peak 6 hours after surgery in the on-pump CABG group and 4 hours after surgery in the OPCAB group. Thereafter, the volume gradually decreased, and 48 hours after surgery the volume decreased in the OPCAB group to 0.064 +/- 1.5 %BW, or to about the same value as the preoperative value, whereas in the on-pump CABG group the volume remained high: 1.9 +/- 2.9 % BW. There was no significant difference between the 2 groups in the change in respiratory-index. The leukocyte count remained significantly higher in the on-pump CABG group. The ECF volume was measured by the bioimpedance measuring method. This is a useful method of measuring the volume non-invasively and continuously. In the OPCAB group, the increase in postoperative ECF volume was less, and recovery to the preoperative level was faster than in the on-pump CABG group.     

Application of off-pump coronary artery bypass grafting for patients with acute coronary syndrome requiring emergency surgery.

Off-pump coronary artery bypass grafting (OPCAB) has become a more applicable procedure, even in patients with multi-vessel disease. However, the role of OPCAB for patients with acute coronary syndrome (ACS) requiring emergency revascularization has not been established yet. We reviewed our results of emergency coronary artery bypass grafting (CABG) for patients with ACS. Seventy-two patients with ACS who underwent emergency CABG were studied. Twenty-five underwent OPCAB and 47 on-pump CABG. OPCAB was mainly indicated for patients who were possibly at risk for cardiopulmonary bypass. When the coronary anatomy was suitable in younger or less risky patients, OPCAB was performed. Patients with multi-vessel disease or with a critical left main trunk lesion were not excluded from OPCAB. The mean number of grafted vessels was 2.6 per patient in the OPCAB group, and 3.8 per patient in the on-pump group (p<0.0001). However, none of the patients in either group required postoperative catheter intervention. Mean operative time was 195 minutes in the OPCAB group and 286 minutes in the on-pump group (p<0.0001). There were three postoperative deaths in the OPCAB group and four in the on-pump group. Multivariate logistic regression analysis revealed that preoperative cardiogenic shock was the only significant predictor for postoperative death (odds ratio, 7.33). The selection of the on-pump procedure or OPCAB did not correlate with operative death. Thus, we conclude that OPCAB can be performed safely and effectively in selected patients with ACS requiring emergency coronary revascularization.     

Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve

Objective: Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon's ‘learning curve’. We examined trends in patient selection over time as a single surgeon's practice evolved to routine OPCAB. Methods: Between 10-1-96 and 12-31-01, 1479 consecutive patients had isolated coronary artery bypass grafting (CABG). Clinical data were gathered prospectively and reviewed retrospectively. Trends in adoption of OPCAB and clinical outcomes were examined. Results: There were 756 OPCAB and 723 CABG/cardiopulmonary bypass patients. The practice evolved from 90% conventional CABG to 93% OPCAB. An abrupt transition coincided with evolution of techniques to expose the obtuse marginal arteries, and improvements in suction-based coronary stabilizers. Mortality was 1.0% for the off-pump group and 2.1% for the on-pump group. Careful patient selection helped maintain acceptable outcomes during the ‘learning curve’. Patients with depressed left ventricular ejection fraction, left main disease, and complex three vessel disease were excluded from OPCAB until significant experience (>200 cases) was attained. Presently, all isolated coronary bypass cases are candidates for OPCAB except patients with ischemic ventricular arrhythmias, those in cardiac arrest, and those for whom previous left pneumonectomy or deep pectus excavatum prevent rightward mobilization of heart. Conclusions: Despite a significant learning curve, evolution to routine OPCAB can be achieved while maintaining good patient outcomes. The development of specialized techniques, coronary stabilizers, and apical suction devices allows the application of OPCAB to virtually all coronary bypass patients, as surgeon experience matures.     

Current status of coronary artery bypass grafting

The number of cases of coronary artery bypass grafting (CABG) reached more than 21 000 in Japan in 2002, and the operative mortality decreased to less than 1%, including emergency operations. The annual number of CABGs in Japan declined 17% after 2003 to 18 000 cases in 2005 owing to unrestricted percutaneous coronary intervention (PCI) with drug-eluting stents. However, CABG is the best treatment for multivessel coronary artery disease based on the comparative data of PCI versus CABG. There have been two trends in CABG during the last decade. One is the widespread use of off-pump (OP) CABG, and the other is multiple coronary artery revascularization. In 2004 and 2005, approximately 60% of all isolated CABG procedures in Japan were performed without cardiopulmonary bypass. In a study of long-term outcomes comparing PCI with drug-eluting stents versus CABG with only arterial grafts, the latter was carried out in 52% of total cases and in 66% of OPCAB cases. OPCAB with multiple arterial grafts has become the standard CABG in Japan.