The Effectiveness of Left Side Pericardiotomy in Off-Pump Coronary Artery Bypass Grafting

iCardiovascular Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan, and Present address:Cardiovascular Surgery, Showa University*, Tokyo, Japanj

Atsushi Aoki* Takanori Suezawa Mitsuhisa Kotani
Shu Yamamoto Mamoru Tago
In off-pump coronary artery bypass graftingiOPCAB), adequate exposure under stable hemodynamic condition is mandatory. We introduced left side pericardiotomy to expose the left anterior descending artery without lifting up the ventricle in 2008. With this pericardiotomy approach, the exposure of the circumflex and right coronary artery territory became easier and OPCAB with left side pericardiotomy was compared with OPCAB with midline pericardiotomy. From 2004 to 2011, 194 elective first time coronary artery bypass graftingiCABGjwere performed in our hospital. Before 2008, 62 patients underwent OPCAB with midline pericardiotomy which constituted 61% of the CABG in that period. After 2008, the pericardium was dissected on the left side and a small pericadiotomy was made on the left side of the main pulmonary artery. This incision was then extended to the apex. With this pericardiotomy, only two patients underwent CABG with cardiopulmonary bypassione patient with 15% left ventricle ejection fraction and one more patient who developed acute coronary syndrome during anesthesia induction). Thus 91 out of 93 patients underwent OPCABi98%jiGroup L). In Group L, old myocardial infarction and unstable angina patients were frequent. The frequency of the patients with left ventricular ejection fraction less than 40% tended to be more in Group L. The operation time was significantly shorter in Group LiGroup M 305}71 min, Group L 223}54, p0.0001jand the number of distal anastomoses number was significantly more in Group LiGroup M 2.3}0.7, Group L 2.8}1.0, p0.0001). Blood pressure during left circumflex coronary artery and right coronary artery anastomosis was significantly higher in Group L, and even continuous dopamine infusion requirement was significantly less in Group Li92% in Group M, 13% in Group L, p0.001jamong the patients with left ventricle ejection fraction less than 60%. There was only 1 hospital death in Group M. Postoperative maximum CK-MB was significantly lower in Group LiGroup M 48}107 IU/l, Group L 13}16 IU/l, p0.005jand the patients with CK-MB more than 12 IU/l was significantly frequent in Group MiGroup M 73%, Group L 33%, p0.0001). Postoperative ICU and hospital stay period was significantly shorter in Group LiICU stay:Group M 3.4}2.3 days, Group L 2.0}1.4 days, p0.0001, hospital stay:Group M 27}21 days, Group L 16}7 days, p0.0001). The patency of the graft to the left anterior descending artery did not differ significantlyiGroup M 94%, Group L 99%), however the patencies of the grafts to left circumflex artery and right coronary artery were significantly better in Group Lileft circumflex artery:Group M 75%, Group L 98%, p0.001, right coronary artery:Group M 81%, Group L 98%, p0.014). Left side pericardiotomy seemed to be useful because OPCAB with left side pericardiotomy yielded shorter operation time, less myocardial enzyme release, improved postoperative recovery and better patency of graft to the left circumflex and right coronary artery.
  Jpn. J. Cardiovasc. Surg. 42:83-88i2013j

KeywordsFoff pump coronary artery bypass grafting, left side pericardiotomy