Off-pump coronary artery bypass surgery in left main coronary artery disease: the last frontier?

Objective: Our aim is to demonstrate the possibility of applying the alternative tactic of off-pump coronary artery bypass surgery to left main coronary artery disease and to assess the long-term results over a 5-year follow-up period. Methods: Among 210 subjects submitted to off-pump coronary artery bypass, 119 (56.7%) were male. Their ages ranged from 32 to 81 years with a mean age of 59.7. A left coronary artery branch lesion of at least 70% was demonstrated in 48 (22.8%) of the individuals and a right coronary lesion was associated in 10 (20.8%) of the cases. Results: A breakdown of the number of grafts per patient was: 2 for 52.1%, 3 for 43.5% and 4 for 4.4% of the surgeries. All of the patients were extubated in the intensive care unit after a 6-hour stay. No left ventricular dysfunction was evidenced after a seven-day total hospitalization period. One death, due to cardiac problems, occurred after one month. Follow-up with clinical cardiac evaluation was total until 60 months with a survival rate at 5 years of 96.0% ± 3.9%. Conclusion: In left main coronary artery disease, which is feared by cardiac surgeons, we believe that the technique of off-pump coronary artery bypass could be very useful. If the patients are hemodynamically stable and undergo an elective operation, the operative period can be passed in a safe and tranquil manner. Descriptors: Myocardial revascularization. Coronary disease. Left main coronary artery. Resumo Objetivo: Demonstrar a possibilidade de aplicar alternativa técnica e tática operatória na lesão do tronco da artéria coronária esquerda com avaliação dos resultados tardios, aos cinco anos de observação. Método: Entre julho de 1998 a março de 2002, 210 pacientes foram submetidos a revascularização miocárdica sem circulação extracorpórea (CEC), sendo 119 (56,7%) do gênero masculino. As idades variaram entre 32 e 81 anos, com média de 59,7 anos e desvio padrão de 10,5 anos. A lesão no tronco da artéria coronária esquerda esteve presente em 48 (22,8%) pacientes, levando em conta graus de lesões acima de 70% e a lesão em artéria coronária direita esteve associada em 10 Rev Bras Cir Cardiovasc 2003; 18(2): 133-136 ORIGINAL ARTICLE