Improving results with additional technique.

OPCAB surgery in obese patients is associated with reduced in-hospital morbidity and mortality rates when compared with conventional surgery with CPB and cardioplegic arrest w12x. In addition, there is compelling evidence that OPCAB surgery is associated with reduced circulating levels of inflammatory mediators, such as interleukin-8, which may have important practical implications because of the participation of this cytokine in neutrophil trafficking and myocardial injury w13x. Although obesity is considered to be a major risk factor in patients undergoing CABG surgery, this study showed that morbid obesity is not a risk factor for in-hospital mortality in this group of patients. This finding is in concurrence with other similar reports w7x. On the contrary, Prabhakar et al. found a significant increase of in-hospital mortality in obese patients who had a BMI higher than 35 kgym. They found that moderate obesity was associated 2 with a slight but statistically significant increase in risk-adjusted increase in mortality and extreme obesity (BMI G40 kgym) had a nearly 50% increase in risk-adjusted 2 mortality w14x. We also did not find any significant difference between obese and non-obese patients in several variables; for example, no difference was found in prolonged mechanical ventilation, length of ICU stays, incidence of AF following CABG surgery between these groups. This finding is in accordance with other studies w7x. An interesting finding of this study is the low incidence of SWI in both groups in spite of the high use of bilateral ITAs in coronary revascularization. The low incidence of SWI may be related to the use of skeletonized harvesting technique and the implementation of tight perioperative glucose control with intravenous insulin. This finding is in agreement with previous studies w15x. Several studies including our own have shown that obese patients are significantly younger w6x. Therefore, it is increasingly important to study the survival of these obese patients after CABG surgery. Obesity is not a risk factor for in-hospital morbidity and all cause hospital mortality after OPCAB aorta no-touch coronary revascularization. Similarly, no differences were found in early postoperative complications, such as stroke, re-exploration for bleeding, AF, acute renal failure, pulmonary complications, prolonged mechanical ventilation, SWI, perioperative need for IABP and psychological complications , in this group of patients. w4x Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Stratification of morbidity and mortality outcome by …