Importance of Anastomotic Sequencing during Off-Pump Coronary Artery Bypass Surgery: A Pilot Strategy

Introduction: Off-pump coronary artery surgery is a method preferred by many surgeons today to avoid the adverse effects of cardiopulmonary bypass. However, this method was quite popular at first but was later abandoned by some surgeons due to unfavorable results. We think the anastomosis sequence is an essential issue when performing off-pump surgery. We aimed to examine the effects of this strategy on the results of off-pump coronary artery surgery.
Methods: We included 601 patients with isolated coronary artery disease who underwent off-pump coronary artery bypass surgery between January 2020 and 2022. The main goal was to ensure sufficient blood was going through the myocardia while anastomosis was performed on one of the coronary arteries. We tried to create a strategy about the sequence in which we should do the coronary anastomosis.
Results: In 2 patients, conversion to on-pump surgery was required in elective conditions due to hemodynamic instability during the operation (0.33%). Only 4 patients required surgical revision because of bleeding (0.67%) in the early postoperative period. We recorded wound infections that could be solved with medical therapy and routine wound dressing in 5 patients (0.83%).
Discussion and Conclusion: After applying this strategy, we experienced much more minor and acceptable conversion rates than those reported in the literature. We believe this strategy will benefit other researchers who have just started practicing off-pump surgery.

Keywords: Off-pump coronary artery bypass surgery, anastomosis sequence, coronary artery disease.