Dysfunction of left ventricle as an indication for off-pump coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Left Ventricular Dysfunction

Background:

• Coronary artery bypass grafting (CABG) using cardiopulmonary bypass poses significant risks for patients with severe left ventricular (LV) dysfunction.
• Patients with impaired LV function often have higher preoperative risk factors, potentially complicating surgical outcomes.

Purpose of the Study:

• To compare the surgical outcomes of off-pump coronary artery bypass grafting (OPCAB) in patients with severe LV dysfunction versus those with normal LV function.
• To evaluate the safety and efficacy of OPCAB in a high-risk patient population.

Main Methods:

• A retrospective study of 240 patients who underwent OPCAB between 1997 and 2000.
• Patients were divided into two groups: Group 1 (90 patients) with ejection fraction (EF) <35% (severe LV dysfunction) and Group 2 (150 patients) with EF >35% (normal LV function).
• Comparison of preoperative risk factors, perioperative mortality, and postoperative complications between the two groups.

Main Results:

• Group 1 had higher predicted mortality (EuroSCORE) and more frequent preoperative risk factors like urgent operation and unstable angina.
• Despite these factors, actual perioperative mortality was comparable between groups (2.5% in Group 1 vs. 1.4% in Group 2).
• Postoperative complications were similar, with only intra-aortic balloon pump use being higher in Group 1; postoperative stay was shorter in Group 1.

Conclusions:

• Off-pump CABG demonstrates similar surgical outcomes for patients with impaired LV function compared to those with normal LV function, even with unfavorable risk profiles.
• Off-pump surgery, particularly with selective arterial revascularization, is a viable and indicated option for patients with poor LV function.