Off-pump coronary artery bypass grafting is safe and effective in patients with severe left ventricular dysfunction

Abstract

OBJECTIVES Severe left ventricular dysfunction (LVD) is associated with increased risk following coronary artery bypass grafting (CABG). Due to a dearth of reports on the choice of CABG technique in patients with LVD, this study aims to compare the outcomes of off-pump CABG (OPCAB) and conventional CABG (ONCAB) in such patients. METHODS Retrospective single-centre propensity-matched analysis comparing early- and long-term outcomes of OPCAB and ONCAB in patients with severe LVD. Primary outcome was long-term all-cause mortality. RESULTS Between 2002 and 2014, a total of 1161 consecutive patients with severe LVD underwent isolated CABG [442 patients underwent OPCAB and 719 ONCAB (430 matched pairs)]. Incomplete revascularization was observed more frequently among OPCAB than ONCAB patients (35.3% vs 21.6%; P < 0.01). The overall 30-day mortality was 5% and was comparable between the matched groups [OR 0.64 (0.34–1.22); P = 0.18]. OPCAB patients had shorter median hospital stay (11 vs 12 days; P = 0.02) and lower packed red blood cell transfusion rates [2.7 (2.21–3.19) vs 4.4 (3.56–5.24); P < 0.01]. Estimated adjusted survival was 86.0% vs 85.8%, 69.1% vs 65.5% and 59.9% vs 49.1% at 1, 5 and 10 years for OPCAB and ONCAB patients, respectively (P = 0.99). Long-term risk of mortality was similar between groups [hazard ratio (HR) 0.94 (0.66–1.32); P = 0.7]. Incomplete revascularization was weakly associated with increased risk of long-term all-cause mortality [HR 1.33 (0.99–1.77); P = 0.05]. CONCLUSIONS OPCAB is safe and effective in patients with severe LVD. Although incomplete revascularization is more commonly observed in patients undergoing OPCAB, it is not associated with increased late mortality.

Off-pump versus on-pump coronary artery bypass graft surgery outcomes in patients with severe left ventricle dysfunction: inverse probability weighted study

“…Although several studies have been compared offpump and on-pump CABG in patients with low EF, the results are conflicting. Few studies showed that OPCABG was associated with lower risk of in-hospital mortality [2,25], and some showed that in-hospital outcomes were the same between OPCABG and ONCABG [31][32][33][34][35]. Regarding mid-and long-term outcomes, in line with our results, some studies showed similar risk between off-and on-pump procedures [33,34].…”

“…Few studies showed that OPCABG was associated with lower risk of in-hospital mortality [2,25], and some showed that in-hospital outcomes were the same between OPCABG and ONCABG [31][32][33][34][35]. Regarding mid-and long-term outcomes, in line with our results, some studies showed similar risk between off-and on-pump procedures [33,34]. There are several conducted studies in this field, although none of them consider individuals genomic and epigenomic profiles composed.…”

Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques

“… 6 , 21 However, it is important to note that learning curve, experience of the team, and case volumes do influence outcomes following these procedures. 22 Left ventricular dysfunction 6 , 23 , 24 and presence of diabetes mellitus, 6 , 25 , 26 , 27 , 28 , 29 as expected, influence long-term outcomes following MIDCAB operations. Nevertheless, female gender has not been found to affect survival rates following MIDCAB.…”

¿Podrían los procedimientos quirúrgicos de revascularización mínimamente invasivos convertirse en el estándar de oro para la cardiopatía isquémica?

“…13 In addition, the low number of distal anastomoses in the off-pump cohorts in the existing studies in the literature raises concerns about incomplete revascularization of heart teams. [9][10][11][12][13][14] In contrast, Diegeler et al showed that patients who underwent OPCAB had lower incidence rates of atrial fibrillation, stroke, and ventilation time, as well as shorter hospital stays, than those who underwent conventional CABG. 14 Despite concerns about the learning curve for this technique and the potential for fewer anastomoses, OPCAB may offer important advantages over traditional CABG for "subgroups of IHD patients".…”