Off-pump coronary bypass for advanced left ventricular dysfunction

In this study the results of off-pump bypass in patients with advanced left ventricular dysfunction (LVD) and without bypassable circumflex disease were analysed retrospectively.

Fifty-five patients with advanced LVD underwent off-pump coronary bypass. Their ages ranged from 39 to 82 years (mean 62.3 +/- 8.4). Forty-two of the patients (76.3%) were in NYHA class III or IV. Mean left ventricular ejection fraction (LVEF) was 23.8 +/- 5.1%. Pre- and intra-operative variables, and postoperative complications and mortality of the patients were analysed. Mid-term follow-up was done by telephone either with the referring cardiologist or the patients.

The mean number of coronary artery bypass grafts (CABG) per patient was 2.22 +/- 0.63. Eight coronary endarterectomies were achieved; early mortality was 3.6%. Pre-operative myocardial infarction (MI) occurred in one patient (1.8%). Two patients (3.6%) were supported with an intra-aortic balloon pump (IABP) and 10 (18.1%) needed inotropic support. Mean postoperative blood loss was 425 +/- 50 cm3. A significant improvement in ejection fraction was observed in the postoperative course. Mean intensive care unit stay was 2.1 +/- 1.1 days and mean hospital stay was 7.2 +/- 1.3 days. The mean follow-up period was 21.8 +/- 6.2 months and mid-term survival was 2.4%. Freedom from cardiac events requiring hospital admission was 89.7%. Most of the patients enjoyed symptomatic relief, however 16 patients (32.6% of survivors) remained in NYHA class III.

These results support the effectiveness of off-pump coronary bypass with good early and mid-term results in patients with ischaemic cardiomyopathy and without bypassable circumflex lesion.