Changes in surgical strategy and techniques of our 10 years experiences with off pump coronary revascularisation

I our Institution between January 1995 and August 2006, out of 4028 isolated CABG, 2174 coronary bypass operations were performed on the beating heart (53.9%), majority off pump – in 107 cases, deliberate use of ECC and beating heart procedure, in 71 pts conversion was instituted. Based on ten years experience, authors draw conclusions from the most frequent tactical and technical pitfalls and mistakes. They particularly emphasize the reasons of the different mistakes which had been observed. The occurance of pitfalls have been analysed. This ten years period was divided in three equal parts. We analysed these time frames in terms of adequacy of the chosen method and possible reasons leading to haemodynamic instability:

• use of stabilization technique and equipment,

• sequences of bypass anastomoses,

• place of coronarotomy,

• usage off cell saver system,

• surgeon's experience.

We also compared the postoperative results of the three period. The analysis of our mistakes helped to improve our results steadily. The most frequent reasons of pitfalls were: lack of experience and skill, proper equipments but not the imperfection of the method. Collective data of off pump surgery in Hungary is continuously increases in the group of isolated CABG procedures: 2001: 20%, 2002: 27%, 2003: 35% 2004: 49, 2005: 58%.