Avoidance of Cardiopulmonary Bypass Improves Early Survival in Multivessel Coronary Artery Bypass Patients with Poor...

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes

Background:

• Coronary artery bypass grafting (CABG) is increasingly performed in patients with diminished ventricular function (ejection fraction ≤30%).
• This patient group represents a high-risk population for CABG procedures.

Purpose of the Study:

• To identify factors influencing outcomes in high-risk patients undergoing CABG with ejection fractions (EF) ≤30%.
• To compare outcomes between off-pump and on-pump CABG in patients with severely reduced ventricular function.

Main Methods:

• Retrospective analysis of 990 patients with EF ≤30% who underwent CABG between January 1997 and September 2002.
• Comparison of 204 off-pump CABG patients versus 713 on-pump CABG patients using univariate and logistic regression analysis.
• Evaluation of differences in mortality, morbidity, and length of stay (LOS).

Main Results:

• Off-pump CABG patients showed a trend toward lower operative mortality (2.9% vs. 6.3%, P=.06) and significantly lower risk-adjusted mortality (1.47% vs. 4.13%, P<.001).
• Off-pump CABG was associated with significantly lower reoperation for bleeding (1.0% vs. 4.6%, P=.02), reduced blood product use (39.6% vs. 66.6%, P<.001), shorter ventilation times, and fewer ICU days.
• Cardiopulmonary bypass (CPB) use (OR 2.4) and prior CABG (OR 2.6) were independent risk factors for mortality.

Conclusions:

• Avoiding CPB in patients with reduced ventricular function undergoing multivessel bypass surgery improves early survival.
• Off-pump CABG significantly decreases the incidence of reoperation for bleeding, blood product usage, and postoperative ventilation duration in this high-risk cohort.
• The findings support the use of off-pump techniques to enhance outcomes for patients with severely impaired ventricular function undergoing CABG.