Individualized off-pump all internal thoracic artery revascularization.

OBJECTIVE: We developed an individualized off-pump approach in an all internal thoracic artery (AITA) composite graft revascularization (AITACR) program to minimize postoperative neurological complications and to obtain the best long-term results possible. Early results of the individualized approach are reported.

PATIENTS AND METHODS: The operative method (on-pump or off-pump) was determined based on institutional selection criteria. Early neurological outcomes were evaluated in 157 men and 42 women; the mean age was 67.3 +/- 9.3 years.

RESULTS: Fifty-nine underwent off-pump procedures and 140 on-pump. The off-pump patients were older than the on-pump patients. The prevalence of diabetes mellitus, history of previous cerebral infarction, and atherosclerotic disease in the ascending aorta was more frequent in the off-pump group than in the on-pump group. The total number of distal anastomoses was 3.2 +/- 0.9 per patient. There was no operative mortality. Three patients (1 in the off-pump group and 2 in the on-pump group) had postoperative cerebral infarctions possibly related to postoperative atrial fibrillation.

CONCLUSIONS: When patients were allocated to the on-pump group or the off-pump group based on our criteria, excellent results were achieved with acceptable morbidity. An individualized off-pump approach in an AITACR program appears reasonable and safe with excellent early neurological outcomes.