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Surgical revascularization in patients with poor left ventricular function: on- or off-pump?

Hani Shennib1, Munemoto Endo, Osama Benhamed

  • 1Division of Cardiothoracic Surgery, The Montreal General Hospital, Quebec, Canada. hani.shennib@muhc.mcgill.edu

The Annals of Thoracic Surgery
|October 29, 2002
PubMed

Insights

Off-pump coronary artery bypass (OPCAB) offers favorable outcomes for patients with poor left ventricular function, demonstrating lower mortality and reduced blood transfusion needs compared to conventional coronary artery bypass (CCAB). This surgical revascularization approach appears safe and effective in high-risk individuals.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Minimally Invasive Cardiac Procedures

Background:

  • Patients with left ventricular dysfunction and low ejection fraction (EF) face elevated risks during coronary artery bypass grafting (CABG).
  • The efficacy of off-pump coronary artery bypass (OPCAB) in this high-risk cohort remains an area of investigation.
  • This study compares OPCAB and conventional coronary artery bypass (CCAB) outcomes in patients with impaired left ventricular function.

Observation:

  • A retrospective analysis included 77 patients with EF ≤ 0.35 undergoing isolated CABG between 1998 and 2001.
  • Operative mortality was 3.2% for OPCAB versus 10.9% for CCAB (p=0.39).
  • OPCAB patients required fewer blood transfusions (p<0.05) and distal anastomoses (p<0.01), but had a higher incidence of atrial fibrillation (p<0.05).

Findings:

  • Off-pump coronary artery bypass (OPCAB) demonstrated comparable safety and potentially better outcomes in patients with poor left ventricular function.
  • The reduced number of grafts in OPCAB did not negatively impact clinical results.
  • Intraaortic balloon pump use was minimal in both groups.

Implications:

  • Off-pump CABG is a viable surgical revascularization option for high-risk patients with reduced ejection fraction.
  • Further research may explore optimizing graft strategies in OPCAB for this population.
  • These findings support the consideration of OPCAB in selected patients with severe left ventricular dysfunction.
Abstract

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