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Related Experiment Videos

Is low ejection fraction safe for off-pump coronary bypass operation?

K V Arom1, T F Flavin, R W Emery

  • 1Cardiac Surgical Associates, Minneapolis, Minnesota 55407, USA. csa@csa-heart.com

The Annals of Thoracic Surgery
|October 4, 2000
PubMed
Summary

Off-pump coronary artery bypass (OPCAB) is suitable for patients with reduced left ventricular function. While OPCAB showed increased enzyme leak and blood loss, it did not predict complications, unlike cardiopulmonary bypass in conventional CABG.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Thoracic Surgery

Background:

  • Assessing hemodynamic stability in patients with depressed left ventricular function undergoing off-pump coronary artery bypass (OPCAB) versus conventional coronary artery bypass (CCAB).
  • Investigating if cardiac manipulation during OPCAB increases hypoperfusion, complications, or mortality compared to CCAB.

Purpose of the Study:

  • To compare the safety and efficacy of OPCAB versus CCAB in patients with ejection fractions ≤30%.

Main Methods:

  • Retrospective review of 177 patients (45 OPCAB, 132 CCAB) with ejection fractions ≤30% from January 1998 to June 1999.
  • Comparison of pre-, intra-, and postoperative variables using univariate and logistical regression analysis.
  • Data sourced from The Society of Thoracic Surgeons National Cardiac Surgery Database.

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Main Results:

  • OPCAB patients tolerated the procedure well despite hemodynamic changes during cardiac displacement.
  • Univariate analysis revealed statistically significant differences in cardiac enzyme leak and blood loss in OPCAB patients.
  • Logistical regression identified cardiopulmonary bypass as the sole predictor of postoperative complications.

Conclusions:

  • Multivessel coronary artery bypass using OPCAB is appropriate for patients with left ventricular ejection fraction ≤30%.
  • No significant difference in variables between CCAB and OPCAB, except for operative/postoperative blood loss and peak cardiac enzyme levels.
  • Meticulous intraoperative management and hemodynamic monitoring are crucial for successful OPCAB outcomes.