Surgical revascularization in patients with poor left ventricular function: on- or off-pump?

Ann Thorac Surg. 2002 Oct;74(4):S1344-7. doi: 10.1016/s0003-4975(02)03966-8.

Abstract

Background: Patients with left ventricular dysfunction and low ejection fraction (EF) are at high-risk of complication and mortality after coronary artery bypass grafting (CABG). The potential success of off-pump CABG in this high-risk population has yet to be determined. The purpose of this study is to compare the outcome of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass (CCAB) in patients with poor left ventricular function, all from a single institution.

Methods: Data on patient demographics, preoperative risk factors, operative and postoperative outcomes were collected retrospectively on all patients having undergone isolated CABG between January 1, 1998, and October 31, 2001.

Results: A total of 77 patients (31 OPCAB/46 CCAB) were identified as having an ejection fraction (EF) of < or = 0.35. Of these, 52 had EF < or = 0.30 (21 OPCAB/31 CCAB) and 31 patients had EF < or = 0.25 (10 OPCAB/21 CCAB). Operative mortality was 3.2% after the OPCAB procedure versus 10.9% for the CCAB (p = 0.39). Use of intraaortic balloon pump (6.5%) was rarely required. The OPCAB procedure resulted in significantly less requirement for blood transfusions (p < 0.05), fewer distal anastomoses per patient (p < 0.01), and a higher incidence of atrial fibrillation (p < 0.05) compared with CCAB.

Conclusions: Patients with poor left ventricular function may undergo surgical revascularization using off-pump technique with relatively good results and low mortality levels. The lower number of grafts performed on the off-pump procedure did not seem to affect clinical outcomes.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Aged
  • Atrial Fibrillation
  • Blood Transfusion
  • Cardiopulmonary Bypass*
  • Coronary Artery Bypass* / mortality
  • Female
  • Humans
  • Intra-Aortic Balloon Pumping
  • Male
  • Middle Aged
  • Risk Factors
  • Stroke Volume
  • Treatment Outcome
  • Ventricular Dysfunction, Left / complications*