Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center

Abstract

BackgroundLimited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction.MethodsA total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared.ResultsPatients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less.ConclusionsThe on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

“…Scientific evidence on the topic derives from retrospective observational studies mainly focused on high-risk patients. Literature search yielded a total of 279 records, and 17 studies 7,10,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28] and two meta-analyses 29,30 published between 2000 and 2020 were finally included in the systematic review (PRISMA flow diagram, Figure 1). Quality assessment is shown in Table 2; study characteristics and collected outcomes are summarized in Tables 3 and 4 and described below.…”

Pump-Assisted Beating-Heart Coronary Artery Bypass Grafting: The Pursuit of Perfection

“…The key findings of this study showed superior outcomes in every category analyzed for the PAD-CAB group ( Figure 5). In 2017, Xia and others compared OP-CAB to PAD-CAB in patients with severe LV dysfunction in 216 consecutive patients [10]. This study was performed by three experienced beating heart surgeons and the decision to employ one technique over the other was not randomized-instead, it was left to the discretion of the surgeon based on the patient's demographics and clinical profile.…”

Moderate Chronic Ischemic Mitral Regurgitation

“…Detailed off-pump and on-pump CABG procedures were obtained from a previous study. 20) Several surgical options were available when considering mitral valve repair. The primary approach was annular repair with a downsized ring annuloplasty.…”