Background: The aim of this study was to evaluate whether full off-pump arterial revascularization could be performed in patients with three-vessel coronary artery disease without any difficulty.

Methods: A total of 40 patients (20 in the off-pump group and 20 in the on-pump group) with three-vessel coronary artery disease were included in this prospective and randomized study, and patients in both groups underwent complete revascularization for the three systems with arterial grafts. Both groups were similar with respect to the preoperative characteristics. In the off-pump group, the left anterior descending artery was revascularized first to provide adequate coronary perfusion during manipulation of the heart for lateral and posterior wall revascularization. Intracoronary shunt was not used in any of these patients.

Results: Both groups were similar for pre- and perioperative risk factors. The mean number of distal anastomoses per patient was higher in the on-pump group (3.2±0.4 versus 3±0; p=0.042). Postoperative transfusion requirements (4.5±2.1 units versus 6.4±1.8 units, p=0.018), extubation time (7.5±2.5 hours versus 10.8±1.8 hours, p<0.05), intensive care unit stay (15.7±5.6 hours versus 54.1±18.3 hours, p<0.05), and hospital stay (5.1±1.5 days versus. 6.9±2.1 days, p=0.004) were found significantly lower in the off-pump group. All left internal thoracic arteries were found patent in the control angiographic studies performed after six months, whereas five right internal thoracic arteries (three in off-pump group and two in on-pump group) and six radial artery grafts (three in off-pump group and three in on-pump group) were occluded.

Conclusion: Full arterial revascularization can be achieved by off-pump bypass techniques in three-vessel coronary artery disease as efficiently as in patients operated under cardiopulmonary bypass.

Keywords : Cardiopulmonary bypass; coronary artery bypass grafting; myocardial infarction; myocardial revascularization; offpump