Off-pump Coronary Bypass Surgery in Patients with Low Ejection Fraction

Gorki, Hagen; Patel, Nirav; Panagopoulos, Georgia; Jennings, Joan; Balacumaraswami, Lognathen; Plestis, Konstadinos A.; Subramanian, Valavanur A.

doi:10.1097/imi.0b013e3181cf8228

Cited by 11 publications

(9 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, these are often very ill patients with multiple comorbidities, and their risk of death from a variety of other causes remains high. Similar to the findings of the aforementioned study based on the Society of Thoracic Surgeons database, 5 a large propensity-match study by Gorki and colleagues 18 on 346 patients showed that the OPCAB group had a 30-day survival benefit, shorter postoperative hospital stay, but no difference in postoperative complications. There was no observed long-term survival difference between on- and off-pump CABG.…”

Section: Discussionsupporting

confidence: 72%

Coronary bypass in left ventricular dysfunction and differential cardiac recovery

Lozonschi

Kohmoto

Osaki

et al. 2017

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Background We aimed to examine the efficacy of surgical revascularization with respect to improvement in ventricular function and survival in patients with ischemic cardiomyopathy and poor left ventricular function. Methods We retrospectively analyzed the data of 429 patients (median age 64.6 years, 81.1% male) with ejection fractions <40% undergoing isolated primary coronary artery bypass grafting from 2000 to 2016. Techniques included on-pump cardioplegic arrest ( n = 312), off-pump ( n = 75), and on-pump beating heart ( n = 42). Propensity matching was performed to compare the cardioplegic arrest group ( n = 114) with the combined off-pump and beating heart groups ( n = 114). Results Postoperatively, ejection fraction increased by 10.1% ± 13.1% (from 31.4% ± 7.1% to 41.6% ± 13.6%; p < 0.001) and mitral regurgitation grade improved ( p < 0.001) but right ventricular function on echocardiographic assessment worsened over time ( p = 0.04). No difference in ejection fraction improvement was seen in the time periods <1 (9.8% ± 11.2%), 1-5 (11.6% ± 14.5%), and >5 (8.8% ± 14.2%) years ( p = 0.442). Following propensity matching, there was no significant difference between the combined off-pump/beating heart and cardioplegic arrest groups with respect to survival or postoperative complications. Conclusions Patients with moderate to severe left ventricular dysfunction experience long-term improvement in left ventricular ejection fraction after coronary artery bypass. However, right ventricular function often continues to decline, contributing to persistent or worsening heart failure symptoms and late mortality. No difference in survival was seen between the 2 techniques.

show abstract

Section: Discussionsupporting

confidence: 72%

Coronary bypass in left ventricular dysfunction and differential cardiac recovery

Lozonschi

Kohmoto

Osaki

et al. 2017

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

show abstract

“…It has been previously shown that in patients with low LVEF who undergo off-pump coronary revascularization via sternotomy, complete revascularization relates to improved survival. 14 We have previously shown that the use of robotic TECAB as part of a hybrid strategy can be effective in achieving complete or near complete revascularization based on residual SYNTAX scores (mean baseline and residual SYNTAX scores 33.1 ± 11.0 and 4.6 ± 6.5, respectively). 15 We believe that this contributes to the outcomes in this cohort as our cardiac-related mortality at a mean follow-up of 37 ± 23 months was only 5%.…”

Section: Discussionmentioning

confidence: 99%

Robotic Off-Pump Totally Endoscopic Coronary Artery Bypass in Patients With Low Ejection Fraction

Peev

Nisivaco

Torregrossa

et al. 2022

Innovations�(Phila)

View full text Add to dashboard Cite

Objective: Robotic totally endoscopic coronary bypass (R-TECAB) has been shown to be a safe and effective technique with excellent outcomes. The aim of this study is to assess the feasibility of R-TECAB in patients with low left ventricular ejection fraction (LVEF) and to report our midterm outcomes with up to 7-year follow-up. Methods: All patients undergoing R-TECAB at our institution between July 2013 and July 2020 were retrospectively reviewed. A total of 100 patients were identified with low LVEF defined as ≤40%. The preoperative characteristics, perioperative and postoperative outcomes, as well as the midterm results were reviewed. Results: The mean LVEF was 31%, and 62% of all patients had preexisting congestive heart failure. Of the cohort, 59% had 3-vessel disease and 6% underwent previous cardiac surgery. Multivessel TECAB was performed in 54%. Hybrid coronary revascularization occurred in 36 individuals. Two patients required cardiopulmonary bypass, and 35% were extubated in the operating room. No sternotomy conversions were required. One patient underwent reoperation for bleeding. No perioperative stroke, myocardial infarction, or mortality occurred. The left internal mammary artery graft patency was 97% at a mean of 1.6 months in the staged hybrid percutaneous coronary intervention group. At midterm follow-up the cardiac-related mortality was 5%. Heart transplant or left ventricular assist device was required in 4 patients, and 1 patient experienced a myocardial infarction. Freedom from major adverse cardiac events was 89%. Conclusions: Off-pump TECAB can be successfully performed in patients with low LVEF in the setting of an experienced and dedicated robotic cardiac surgery team. Our data demonstrate the feasibility of the technique with excellent perioperative and midterm outcomes.

show abstract

“…Furthermore, inhospital mortality rates for patients who underwent unplanned conversions were high (12.5% and 9.3%, respectively). A study that propensity matched 346 low LVEF OPCAB patients with a historical cohort of ONCAB patients, noted similar survival at 8 years and suggested that OPCAB may be a viable alternative to improve early outcomes but did not appear to have a survival advantage 10 . Additionally, another unmatched retrospective analysis of patients with left ventricular dysfunction from the late 1990s and early 2000s found similar rates of 10‐year survival between OPCAB and ONCAB patients 15 .…”

Section: Discussionmentioning

confidence: 99%

“…While numerous randomized control trials (RCTs) and meta‐analyses evaluating the potential benefits of OPCAB in the general population have been conducted, the indications for OPCAB and its effect on clinical outcomes remain controversial 2‐6 . Notably, several observational studies that have evaluated high‐risk subpopulations such as patients with reduced LVEF, who are typically excluded from inclusion in RCTs, have shown OPCAB to reduce early morbidity and mortality 7,8,10 . Currently, the longitudinal impacts of OPCAB remain unclear due to the fact that the majority of studies investigating OPCAB in reduced LVEF patients are constrained to immediate postoperative assessments, include patients from prior eras, or have longitudinally followed groups of OPCAB and ONCAB patients, with unbalanced degrees of complete revascularization.…”

Section: Discussionmentioning

confidence: 99%

Off‐pump coronary artery bypass surgery lacks a longitudinal survival advantage in patients with left ventricular dysfunction

et al. 2020

View full text Add to dashboard Cite

Background This study evaluates the longitudinal impacts of off‐pump coronary artery bypass (OPCAB) surgery in patients with reduced left ventricular ejection fraction (LVEF). Methods Adults with LVEF ≤ 30% undergoing coronary artery bypass grafting between 2011 and 2020 were included. Patients were stratified based on the utilization of cardiopulmonary bypass into OPCAB or on‐pump coronary artery bypass (ONCAB) groups. Primary outcomes included survival and hospital readmissions. Secondary outcomes evaluated postoperative morbidities. Multivariable regression evaluated risk‐adjusted mortality and readmission. Propensity score matching was utilized to reduce bias. Results A total of 660 low LVEF patients were included, of which 28.5% (n = 188) were OPCAB and 71.5% (n = 472) were ONCAB. The rates of complete revascularization were similar between the groups (80.3% vs 82.0%; P = .67). Early survival between the unmatched groups was similar at 1‐year follow‐up (86.2% vs 87.9%; P = .53); however, at 5 years OPCABs had significantly worse survival compared with ONCABs (71.5% vs 64.2%; P = .02). These findings persisted in the matched cohort where survival at 1 year was comparable (86.8% vs 85.7%; P = .80), but 5‐year survival was better for ONCABs (64.1% vs 69.9%; P = .03). The rates of readmission were similar between the unmatched and matched groups at all time intervals, including readmissions for cardiac‐related and heart failure‐related events (all, P > .05). Conclusions In contemporary patients with reduced LVEF, survival after OPCAB was similar at 1 year but lower at 5‐year follow‐up compared with ONCAB, despite similar rates of complete revascularization. These findings suggest that there may be other factors influencing longitudinal mortality in the low LVEF cohort, beyond the use of cardiopulmonary bypass.

show abstract

Off-pump Coronary Bypass Surgery in Patients with Low Ejection Fraction

Cited by 11 publications

References 68 publications

Coronary bypass in left ventricular dysfunction and differential cardiac recovery

Coronary bypass in left ventricular dysfunction and differential cardiac recovery

Robotic Off-Pump Totally Endoscopic Coronary Artery Bypass in Patients With Low Ejection Fraction

Off‐pump coronary artery bypass surgery lacks a longitudinal survival advantage in patients with left ventricular dysfunction

Contact Info

Product

Resources

About