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Off-pump revascularization for significant left ventricular dysfunction

Y Joseph Woo1, Todd J Grand, George P Liao

  • 1Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, 6 Silverstein Pavilion 3400 Spruce St., Philadelphia, PA 19104, USA. wooy@uphs.upenn.edu

Asian Cardiovascular & Thoracic Annals
|July 27, 2006
PubMed

Insights

Off-pump coronary artery bypass grafting (CABG) offers a safe revascularization alternative for patients with poor left ventricular function. This approach yields outcomes comparable to those with normal ventricular function, minimizing perioperative risks.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Heart Failure Research

Background:

  • Left ventricular dysfunction (LVD) significantly increases perioperative risks in traditional on-pump coronary artery bypass grafting (CABG).
  • Cardiopulmonary bypass and myocardial ischemia during on-pump CABG can exacerbate physiological insult in patients with compromised ventricular function.

Purpose of the Study:

  • To evaluate the safety and efficacy of off-pump coronary artery bypass grafting (OPCAB) in patients with poor left ventricular ejection fraction (LVEF).
  • To compare outcomes of OPCAB in patients with poor LVEF versus those with normal LVEF.

Main Methods:

  • Retrospective analysis of non-emergency OPCAB procedures performed by a single surgeon over 18 months.
  • Comparison of two groups: poor LVEF (10%-35%) and normal LVEF (55%-80%).
  • Analysis of graft number, time to extubation, and length of hospital stay.

Main Results:

  • Patients with poor LVEF (mean LVEF 26%) received 2.8 grafts/patient, were extubated in 8.4 hours, and discharged in 4.9 days.
  • Outcomes in the poor LVEF group were statistically equivalent to the normal LVEF group (mean LVEF 63%).
  • No intraaortic balloon pump insertion or mortality was observed in either group.

Conclusions:

  • Off-pump coronary artery bypass grafting is an effective and safe revascularization strategy for patients with significant left ventricular dysfunction.
  • OPCAB presents a valuable alternative for patients with ischemic cardiomyopathy and reduced LVEF, potentially avoiding the risks associated with cardiopulmonary bypass.

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