Abstract:

Objective   To make a comparative analysis of the clinical results of onpump beating heart and offpump coronary artery bypass surgery in patients with left main disease. Methods   Consecutive 180 isolated multiple coronary artery bypass patients entered into off-pump coronary artery bypass(group OPCAB，n=90) or coronary artery bypass with cardiopulmonary bypass beating heart(on-pump beating heart OPBH)(group OPBH， n=90). Before surgery there was no significant difference between the two groups with regards to the degree of angina， history of myocardial infarction, COPD, diabetes, hypertension, hyperlipidemia, stroke and impaired renal function． Group OPBH had more patients with low LVEF(P<0．05). All patients had coronary bypass surgery through full sternotomy. Group of OPBH underwent the support of CPB but Group OPCAB without. Single deep pericardial stay suture with a sling snared down was used to expose the target coronary vessels in group OPCAB，  along with the stabilizers and coronary shunts. Medi-StimButterfly Flowmeter was used to measure the flow grafts in both groups. Results    No one in group OPCAB was needed to be converted into OPBH. The mean number of the distal anastomosis and the ICR (index of completeness of revascularization) is similar in both groups. The respiratory support time， the chest tube drainage and blood transfusion are less in group OPCAB than in group OPBH post-operatively (P<0.05, P<0.01); There is no significant difference in the mortality and other morbidities (peri-operative MI， reopen, respiratory dysfunction, renal dysfunction, stroke，atrial fibrillation, mediastinitis, low extremity infection). Conclusion    Comparing to OPCAB, to patients of low LVEF, OPBH can be applied to patients with left main disease  can achieve similar completeness of revascularization, similar early surgica1 results with longer respiratory support， more transfusion requirement， more ICU stay time.

Key words: Off-pump; On-pump beating heart; Coronary artery bypass; Left main disease; Complete revascularization