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Objective <p>The intense competition with percutaneous catheter interventions has led to a treatment approach unique to Japan. Off-pump coronary artery bypass grafting (OPCAB) has become mainstream in the country. Since 2000, we have adopted an OPCAB-first approach. This study evaluated our institutional data to determine whether outcomes improved over time.</p> Methods <p>A total of 1172cases of elective isolated coronary artery bypass grafting were performed at our hospital from 2000 to 2023. The cases were divided into four periods (Q1–Q4). Ischemic cardiac events were defined as cardiac death, myocardial infarction, chest pain or heart failure related to myocardial ischemia.</p> Results <p>The proportion of patients with three-vessel disease, diabetes, cardiac dysfunction, and those require dialysis gradually increased, indicating a trend toward more severe cases. The rate of OPCAB procedures increased until Q3 but decreased in Q4. The use of arterial grafts showed a decreasing trend, while the use of saphenous vein grafts (SVGs) increased from Q3 onward. The no-touch SVG technique was employed in 55% of cases in Q4. Five-year survival rates were better in Q1 than in Q3 (<i>p</i> = 0.01). However, cardiac death-free rates and ischemic cardiac event–free rates did not differ significantly (<i>p</i> = 0.62, <i>p</i> = 0.26).</p> Conclusions <p>The surgical strategy has shifted from extensive use of OPCAB and arterial grafts to more frequent use of cardiopulmonary bypass and SVGs when necessary. Both survival and event-free rates demonstrated an improving trend, highlighting the increasing importance of tailoring treatment strategies to individual patients.</p>

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The 20-year long-term outcomes of coronary artery bypass grafting: An off-pump first approach

  • 期刊论文

  • 发表日期：

    2026年1月31日

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  • Tatsuhiko Komiya,
  • Shingo Hirao,
  • Jiro Sakai,
  • Go Yamashita,
  • Atsushi Sugaya

摘要

Objective

The intense competition with percutaneous catheter interventions has led to a treatment approach unique to Japan. Off-pump coronary artery bypass grafting (OPCAB) has become mainstream in the country. Since 2000, we have adopted an OPCAB-first approach. This study evaluated our institutional data to determine whether outcomes improved over time.

Methods

A total of 1172cases of elective isolated coronary artery bypass grafting were performed at our hospital from 2000 to 2023. The cases were divided into four periods (Q1–Q4). Ischemic cardiac events were defined as cardiac death, myocardial infarction, chest pain or heart failure related to myocardial ischemia.

Results

The proportion of patients with three-vessel disease, diabetes, cardiac dysfunction, and those require dialysis gradually increased, indicating a trend toward more severe cases. The rate of OPCAB procedures increased until Q3 but decreased in Q4. The use of arterial grafts showed a decreasing trend, while the use of saphenous vein grafts (SVGs) increased from Q3 onward. The no-touch SVG technique was employed in 55% of cases in Q4. Five-year survival rates were better in Q1 than in Q3 (p = 0.01). However, cardiac death-free rates and ischemic cardiac event–free rates did not differ significantly (p = 0.62, p = 0.26).

Conclusions

The surgical strategy has shifted from extensive use of OPCAB and arterial grafts to more frequent use of cardiopulmonary bypass and SVGs when necessary. Both survival and event-free rates demonstrated an improving trend, highlighting the increasing importance of tailoring treatment strategies to individual patients.