Off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction

Abstract

IntroductionThe prevalence of patients presenting with severe left ventricular dysfunction is increasing together with an increasing profile of co-morbidities 1 . Severe left ventricular (LV) dysfunction has been reported as an independent predictor of operative mortality in patients undergoing coronary artery bypass grafting 1-4 . Offpump technique has theoretical and practical advantages over conventional coronary artery bypass grafting in this subset of high risk patients. Multiple studies showed that CABG results in considerable improvement in long-term survival, as well as, improvement in ejection fraction and symptomatic class 1,3 . Off-pump coronary artery bypass grafting (OPCAB) has become a valid treatment for coronary artery disease especially for those with cerebrovascular AbstractObjective : Off-pump coronary artery bypass grafting (OPCAB) is known to preserve left ventricular function better than conventional coronary artery bypass grafting (CCAB). This study was carried out to investigate the safety, feasibility and efficacy of off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction. Methods: Three hundred and eighty eight consecutive patients with preoperative left ventricular ejection fraction < 39% who underwent CABG between January 2001 through October 2007 were included in this retrospective study. Two hundred and eleven patients were operated by off-pump technique (group 1) and 178 patients were operated by on-pump technique (CCAB) (group 2). The postoperative outcomes were analyzed. Of these, 204 (52.57%) patients were diabetics, 355 (91.49%) patients had documented prior myocardial infarction, 316 (81.44%) patients were in canadian cardiovascular society(CCS) class III and 47 (12.11%) patients were in CCS class IV.Results: There was no significant difference in the number of grafts per patient between the two groups [group 1 3.02 ± 0.76 vs group 2 3.18 ± 0.72 (P=0.07) and the index of completeness of revascularization was comparable [1.08 ± 0.08) (OPCAB) vs 1.04 ± 0.06 (CCAB) (p=0.52)] The left internal thoracic artery was anastomosed to left anterior descending artery in 98% of patients. Operative mortality was 2.8% (6 deaths) following OPCAB and 3.93% (7 deaths) following CCAB (p=0746). Postoperative usage of IABP support was higher in CCAB group (12 patients vs 4 patients: P<0.03) and usage of moderate or higher doses of inotropic support was also higher in the conventional group (p<0.0006). More worsening of preexisting renal insufficiency was observed in CCAB group (p=0.01) and no significant difference in the incidence of atrial fibrillation was observed between the groups.Conclusions: Off-pump coronary artery bypass grafting is feasible and safe in patients with depressed left ventricular function and the postoperative morbidity was less in OPCAB group compared to on-pump group. (Ind J Thorac Cadiovasc Surg 2008; 24: 110-115)

Comparison of Early Outcome of Off-pump and Conventional Coronary Artery Bypass Graft Surgery in Patients with Multivessel Coronary Artery Disease and Left Ventricular Dysfunction

“…Ruzzeh et al in amulti-centre comparative analysis showed similar result (1.4% vs. 2.9%)5 . But, Sajja et al (2.8% vs.3.9%, p=0.746) showed a bit different results 26. …”

Atrial Fibrillation, Blood Loss, and Transfusion in Patients With Left Ventricular Dysfunction

“…Fifteen studies reported the incidence of new AF in [17][18][19][20][21][22]24,[27][28][29][30][31][32][33]37 : 334 of 2004 (16.7%) OPCAB patients and 725 of 3466 (20.9%) ONCAB patients. Fifteen studies reported the incidence of new AF in [17][18][19][20][21][22]24,[27][28][29][30][31][32][33]37 : 334 of 2004 (16.7%) OPCAB patients and 725 of 3466 (20.9%) ONCAB patients.…”

“…Using a randomeffect model (Figure 2), the OR was 0.77 (95% confidence interval [CI] 0.58-1.02, p = 0.07) with moderate heterogeneity, and with a fixed-effect model the OR was 0.75 (95%CI 0.65-0.88, p = 0.002) with moderate heterogeneity. Eight studies reported the proportion of patients requiring a blood transfusion 18,21,22,[28][29][30][31]36 : 450 of 1063 (42.3%) OPCAB and 1309 of 2268 (57.8%) ONCAB patients. Four studies (with a total of 526 OPCAB and 1169 ONCAB patients) reported estimated blood loss.…”

“…Four studies (with a total of 526 OPCAB and 1169 ONCAB patients) reported estimated blood loss. Sixteen studies reported the proportion of patients requiring reoperation for bleeding [16][17][18][19]21,[23][24][25]27,28,[30][31][32][35][36][37] : 63 of 2407 (2.6%) and 155 of 4415 (3.5%) ONCAB patients. Proportion requiring blood transfusion.…”

“…16,17,21,[26][27][28][29][31][32][33][34][35]37 The OPCAB group was associated with a significantly shorter hospital stay (random-effect model: WMD −1.53; 95%CI −2.34, −0.73, p = 0.0002) with significant heterogeneity across the studies. Thirteen studies reported the postoperative length of stay.…”