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Multivessel off-pump revascularization in patients with severe left ventricular dysfunction
Daniel J Goldstein1, Robert B Beauford, Brandon Luk
1Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center and Saint Barnabas Hospital, 201 Lyons Avenue, Newark, NJ 07112, USA. dgoldstein@sbhcs.com
Insights
Multivessel off-pump coronary artery bypass grafting (CABG) is safe and effective for patients with severe left ventricular dysfunction. This approach offers improved survival and quality of life compared to conventional CABG.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Severe left ventricular dysfunction poses significant challenges for coronary artery bypass grafting (CABG).
- Beating heart revascularization aims to improve outcomes in high-risk cardiac surgery patients.
Purpose of the Study:
- To evaluate the safety and efficacy of multivessel off-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular dysfunction.
- To provide intermediate survival and quality of life data for this patient group.
Main Methods:
- A prospectively updated database was queried for patients with ejection fraction <=30% undergoing off-pump CABG.
- Outcomes were compared to Society of Thoracic Surgeons (STS) benchmarks and a concurrent conventional CABG cohort.
- Survival and quality of life were assessed via telephone interviews.
Main Results:
- One hundred off-pump CABG patients (mean EF 26%) showed a 3% observed mortality versus 5.3% predicted (O/E ratio 0.56).
- Adverse event rates were favorable compared to STS benchmarks and a conventional CABG cohort.
- One-year survival was 85%, with 88% freedom from cardiac readmission and 83% freedom from angina.
Conclusions:
- Multivessel off-pump CABG is a safe and effective alternative for patients with severe left ventricular dysfunction.
- Intermediate outcomes suggest benefits in survival and quality of life.
- Long-term follow-up is necessary to confirm these findings.
Objective:
The purpose of this study was to investigate the safety and efficacy of multivessel beating heart revascularization in a high-risk group of patients with severe left ventricular dysfunction as well as to provide intermediate survival and quality of life data.
Methods:
Our prospectively updated database was queried to extract all patients with left ventricular ejection fraction < or =30% who underwent beating heart revascularization. Standard demographics, clinical profiles and outcomes were collected. Outcomes were compared with Society of Thoracic Surgeons (STS) benchmarks for all coronary artery bypass grafting (CABG) patients. Telephone interviews were conducted and survival and quality of life data were tabulated. In addition, morbidity and mortality outcomes were compared with a concurrent cohort of patients with similarly impaired left ventricular function who underwent conventional coronary artery bypass.
Results:
One hundred off-pump coronary artery bypass grafting patients were identified and follow-up was 93% complete in these patients. Mean age was 67+/-10.5 years and mean ejection fraction was 26+/-4%. Twenty-one percent were females. Balloon counterpulsation support was used liberally in the perioperative period. Patients received a mean of 3.5 grafts with 83% internal mammary artery use. Observed mortality was 3% with a predicted mortality of 5.3%. Observed to expected ratio was 0.56. Incidence of adverse events compared favorably with both that reported in the STS for all CABG patients regardless of left ventricular function, and also to a concurrent CABG cohort. One-year survival was 85%. Freedom from cardiac readmission was 88% and freedom from angina was 83%. No patient required repeat percutaneous or surgical intervention.
Conclusions:
We conclude that multivessel off-pump revascularization in patients with severe left ventricular dysfunction is a safe and effective alternative to conventional grafting. Long-term follow-up is mandatory to confirm these encouraging intermediate outcomes.
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