**11. Results**

We had analyzed the results of our last 2000 OPCAB patients. It was noticed that we had a higher rate of conversion onto the heart lung machine in our first thousand, when compared the second thousand. Probably, that was our initial learning curve which was seen in our technique, which we have developed and standardized. The use of IABP had been low in the early years, and probably the reason for the increased conversion on to the Heart lung machine. But as we understood the use of IABP, we found it more user friendly. Also the need

Re-Engineering in OPCAB Surgery 199

In our last 12 years of OPCAB experience and over 2500 OPCABs, we have been able to perform the last 1600 OPCABs with only one conversion to the heart lung machine. That was when patient developed intractable arrhythmia. Hence in our opinion, intractable arrhythmia is the only reason for conversion. The mortality in the first one thousand patients have been 0.8% and in the second thousand is 0.4%.This proves to say that OPCAB has definitely reduced the mortality in coronary surgery. And if trained well we would be

Akiyama K., Ogasawara K., Inoue T., Shindou S., Okumura H., Negishi N., Sezai Y.

Al-Ruzzeh S., George S., Yacoub M., Amrani M. The clinical outcome of off-pump coronary

A. Laurie Shroyer, Ph.D., Frederick L. Grover, M.D., Brack Hattler, M.D., Joseph F. Collins,

Anil D Prabhu, MCh, Ismail E Thazhkuni, PhD, Sunil Rajendran, MRCS, Ranjish A

Anil D. Prabhu, MCh, Rafeek A. Karim, MCh, Sunil Rajendran, FRCS, Ismail E. Thazhkuni,

Ankeney JL. To use or not use the pump oxygenator in coronary bypass operations Ann

Arom K.V., Flavin T.F., Emery R.W., Kshettry V.R., Janey P.A., Petersen R.J. Safety and

Ascione R., Lloyd C.T., Gomes W.J., Caputo M., Bryan A.J., Angelini G.D. Beating versus

Ascione R., Lloyd C.T., Underwood M.J., Gomes W.J., Angelini G.D. On-pump versus off-

Ascione R., Nason G., Al-Ruzzeh S., Ko C., Ciulli F., Angelini G.D. Coronary

efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 2000;69:704-

arrested heart revascularization: evaluation of myocardial function in a prospective

pump coronary revascularization: evaluation of renal function. Ann Thorac Surg

revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency. Ann Thorac Surg

operative risk factors. Ann Thorac Cardiovasc Surg 1999;5:31-35

Bypass (ROOBY) Study Group.N Engl J Med 2009; 361:1827-1837.

10.1532/HSF98.20071155 http://cardenjennings.metapress.com

randomized study. Eur J Cardiothorac Surg 1999;15:685-690.

Myocardial revascularization without cardiopulmonary bypass in patients with

artery bypass surgery in the elderly patients. Eur J Cardiothorac Surg 2001;20:1152-

Sc.D., Gerald O. McDonald, M.D., Elizabeth Kozora, Ph.D., John C. Lucke, M.D., Janet H. Baltz, R.N., and Dimitri Novitzky, M.D., Ph.D. for the Veterans Affairs Randomized On-Pump versus Off-Pump Coronary-Artery Bypass Surgery.On/Off

Thamaran, MS, Kannan A Vellachamy, MD, Murali P Vettath, MD. Mammary patch reconstruction of left anterior descending coronary artery.*Asian Cardiovasc* 

PhD, Ranjish A. Thamaran, MS, Kannan A. Vellachami, MD,Murali P.Vettath, MCh. Vettath's technique of long mammary patch reconstruction of a diffusely diseased left anterior descending coronaryartery without endarterectomy on the beating heart.The Heart Surgery Forum #2007-1155 11 (2) P 64-67, 2008 doi:

able to perform the same in patients with any ejection fraction.

**13. References** 

1156.

710.

1999;68:493-498.

2001;72:2020-2025

*Thorac Ann 2008;16:313-317* 

Thorac Surg 1975;19:108-109.

for the balloon pump only for distal anastomosis did come as a surprise to us. In the last 1600 odd patients, we had to convert only one patient on to the heart lung patient (That too when the patient developed intractable Ventricular arrhythmia). The mortality of the second thousand patients had come down by half and we have been able to maintain that result.

Our results of the different parameters like the use of ionotropes, number of grafts, Renal failure, perioperative Myocardial infarction etc, in comparison with our two groups of patients have been elucidated in the Table below.

