Long-term analysis of ventricular function in patients with symptomatic coronary disease who underwent on-pump or off-pump coronary artery bypass grafting

Rafael Rocha Mol Silva; Whady Hueb; Eduardo Gomes Lima; Paulo Cury Rezende; Paulo Rogério Soares; José Antonio Franchini Ramires; Roberto Kalil Filho

doi:10.1186/s13019-022-02069-1

Long-term analysis of ventricular function in patients with symptomatic coronary disease who underwent on-pump or off-pump coronary artery bypass grafting

J Cardiothorac Surg. 2022 Dec 19;17(1):326. doi: 10.1186/s13019-022-02069-1.

Authors

Rafael Rocha Mol Silva¹, Whady Hueb², Eduardo Gomes Lima¹, Paulo Cury Rezende¹, Paulo Rogério Soares¹, José Antonio Franchini Ramires¹, Roberto Kalil Filho¹

Affiliations

¹ Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 - AB 1 S114 Cerqueira Cesar, São Paulo, SP, CEP - 05403-000, Brazil.
² Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 - AB 1 S114 Cerqueira Cesar, São Paulo, SP, CEP - 05403-000, Brazil. whady.hueb@incor.usp.br.

Abstract

Background: Systemic deleterious effects of cardiopulmonary bypass have been observed in the postprocedural period. Long-term assessment, including ventricular function (VF), is unclear. The objective of this study was to compare the change of left ventricular ejection fractions (LVEFs) during a long-term follow-up of coronary artery disease (CAD) patients who underwent off-pump (OPCAB) or on-pump coronary artery bypass grafting (ONCAB).

Methods: This study is a prespecified analysis of the MASS III trial, which was a single-center and prospective study that enrolled stable CAD patients with preserved VF. The CAD patients in our study were randomized to OPCAB or ONCAB. A transthoracic echocardiogram was performed during follow-up and a LVEF value was obtained. The primary endpoint was the difference between the final LVEF and the baseline LVEF.

Results: Of the 308 randomized patients, ventricular function were observed in 225 over a mean of 5.9 years of follow-up: 113 in the ONCAB group and 112 in the OPCAB group. Baseline characteristics were similar between the two groups, but there was a larger proportion of subjects with 3-vessel disease in the ONCAB group. There was no difference in the LVEF at the beginning (P = 0.08), but there was a slight decrease in the LVEF in the ONCAB and OPCAB groups (P < 0.001 in both groups) at 5.9 years. The decline was not significantly different between the two groups (delta of -6% for ONCAB and -5% for OPCAB; P = 0.78). In a multivariate analysis, myocardial infarction in the follow-up was a predictor of an LVEF < 40%.

Conclusions: There was no difference in the long-term development of ventricular function between the surgical techniques, despite a decline in the LVEF in both groups. Trial registration Clinical Trial Registration Information-URL: http://www.controlled-trials.com .

Registration number: ISRCTN59539154. Date of first registration: 10/03/2008.

Keywords: Coronary artery bypass grafting; Coronary artery disease; Off-pump; On-pump; Ventricular function.

Publication types

Randomized Controlled Trial

MeSH terms

Coronary Artery Bypass / methods
Coronary Artery Disease* / surgery
Humans
Prospective Studies
Treatment Outcome
Ventricular Function, Left