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

Abstract

Objective In this study we aimed to compare on-pump and off-pump coronary artery bypass grafting (CABG) outcomes in patients presented with low left ventricular ejection fraction (EF) as a high-risk group of patients. Methods In this registry-based study from 2014 and 2016, all patients with severe left ventricular dysfunction (EF less than 35%) were included and followed until 2020. The median follow-up period was 47.83 [38.41, 55.19] months. Off pump CABG (OPCABG) was compared with on-pump CABG (ONCABG) in terms of mid-term non-fatal cardiovascular events (CVEs) and all-cause mortality. Propensity score method (with inverse probability weighting technique) was used to compare these two groups. Results From 14,237 patients who underwent isolated CABG, 2055 patients with EF ≤ 35% were included; 1705 in ONCABG and 350 patients in OPCABG groups. Although OPCABG was associated with lower risk of 30-days mortality (Odds Ratio [OR]: 0.021; Confidence Interval [CI] 95% [0.01, 0.05], P < 0.001); there was no significant difference between OPCABG and ONCABG in term of mid-term mortality and non-fatal CVEs ((Hazard ratio [HR]: 0.822; 95%CI [0.605, 1.112], p = 0.208) and (HR: 1.246; 95%CI [0.805, 1.929], p = 0.324), respectively). Patients with more than three traditional coronary artery disease risk factors, had more favorable outcomes (in terms of mid-term mortality) if underwent OPCABG (HR: 0.420; 95%CI [0.178, 0.992], p = 0.048). Conclusion OPCABG was associated with lower risk of 30-days mortality; however, mid-term outcomes were comparable in both OPCABG and ONCABG techniques.

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

“…The high proportion of male patients may have reduced the effect of gender on the statistical results. Mid-term survival and cardiovascular adverse event trends for on-pump CABG and off-pump CABG have been suggested to be comparable [ 12 , 13 ]. But on-pump CABG and off-pump CABG may differ in serum cytokine and chemokine levels and oxidative stress status, which may affect postoperative outcomes [ 14 , 15 ].…”

Intensive care unit length of stay and mortality comparison between on-pump and off-pump coronary artery bypass graft: a retrospective study

“…Factors such as patient tolerance, disease progression, procedural complexity, and postoperative recovery influence mortality rates in CABG surgery [ 14 ]. Complications are more common with ONCABG, which may explain its lower death rate than OPCABG [ 15 ]. However, our study found no significant difference in mortality between the two techniques.…”

Comparison of outcomes between off-pump and on-pump coronary artery bypass graft surgery using collaborative targeted maximum likelihood estimation

“…Smoking and opium are associated with cardiac function decline. For patients with ventricular dysfunction, off-pump CABG has better outcomes 49 . The unmeasured variables in our study were indicated as U and directed by a dotted arrow (U1 is lifestyle).…”