10-year experience with off-pump coronary artery bypass surgery at the Heart Institute Lahr/Baden

AbstractBased on 10 years' experience on more than 1500 patients, we present relevant data and discuss important aspects of a successful implementation of OPCAB. First, an intradepartmental debate about possible OPCAB strategies is necessary. A common strategy where patients are selected according to “OPCAB feasibility” or expected risk of HLM complications is from the theoretical viewpoint and according to our experience not recommendable. In order to implement OPCAB as a routine procedure in daily practice, great expertise of the surgeons, the anesthesiologists and the rest of the team, is necessary for the development of routines and to achieve good results. We recommend a decision-making algorithm where the first choice procedure and the alternatives are defined. We favor the “Total OPCAB Approach” where complete revascularization is performed with LIMA and sequential RIMA with T-graft insertion into the LIMA. Such a clear concept and the role model of the chief of the department, who provides also psychological safety, as well as a structured (codified) OPCAB technique, which is easy to adapt by others, are the most important factors ensuring a successful implementation process. A commitment of the main persons responsible in the department to such a concept becomes even more important because the OPCAB benefit is rarely noticeable in daily practice, but only in larger series. In our experience since 2005 it is remarkable that no stroke occurred directly postoperative and cardiac enzymes as well as other laboratory values like lactate dehydrogenase were significantly lower postoperative than after conventional CABG.