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Sequential bypass on the beating heart can be achieved without compromising patient safety or regional myocardial blood flow.

For some cardiac surgeons, operating on the beating heart is the preferred method of coronary revascularization. In an effort to minimize manipulation of the aorta, we have used, in addition to an internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery, a sequential reversed saphenous vein graft (rSVG) to revascularize the lateral, inferior, and posterior myocardium with a single proximal aortic anastomosis. In this report, we retrospectively summarize a recent series of off-pump coronary bypass grafting (OPCABG) cases, including the evaluation of distal conduit blood flow. Between January 1, 2005, and January 1, 2007, a consecutive series of 175 patients underwent OPCABG with 1 IMA graft and 1 sequential rSVG performed by a single surgeon (RLQ). The average number of grafts/patient was 3.4 (range, 3-5). Flow rates were measured in each segment of the sequential graft using a Transonic Flowmeter (HT314, Transonic Systems Inc, Ithaca, NY). All patients were given PO clopidogrel (75 mg/d) for 6 weeks beginning on postoperative day #1. Mean flow through the distal segment of the sequential venous bypass was 36 ml/min, which was not significantly influenced by the number of proximal coronary anastomoses nor by the size of the proximal coronary bed. The 30-day mortality and stroke rate was 0% (0/175). The incidence of postoperative atrial fibrillation in those patients with normal baseline sinus rhythm was 29% (49/169). No postoperative myocardial infarctions [enzyme/electrocardiographic (ECG) criteria] nor renal failure requiring dialysis occurred. As the complexity of the surgical candidate continues to increase, less invasive approaches to coronary revascularization will prevail. The results of this retrospective study indicate that this technique is safe, and that regional coronary blood flow is not compromised by the creation of sequential anastomoses.