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

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.