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Published on: September 15, 2023
Off-pump coronary bypass for advanced left ventricular dysfunction
F Nurözler1, S T Kutlu, G Küçük
1Division of Cardiovascular Surgery, Central Hospital, Izmir, Turkey.
Insights
Off-pump coronary bypass surgery demonstrated effective early and mid-term outcomes in patients with advanced left ventricular dysfunction and no bypassable circumflex disease. This surgical approach offers a viable option for complex cardiac cases, improving ejection fraction and survival rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Retrospective analysis of off-pump coronary artery bypass (CABG) in patients with advanced left ventricular dysfunction (LVD).
- Exclusion criteria included bypassable circumflex coronary artery disease.
- Focus on patients with ischemic cardiomyopathy and compromised heart function.
Purpose of the Study:
- To evaluate the effectiveness and safety of off-pump coronary bypass surgery.
- To assess early and mid-term outcomes in a specific patient cohort.
- To analyze postoperative complications and survival rates.
Main Methods:
- Retrospective review of 55 patients with advanced LVD undergoing off-pump CABG.
- Analysis of pre-operative, intra-operative, and post-operative data.
- Mid-term follow-up via telephone with referring cardiologists or patients.
Main Results:
- Mean grafts per patient: 2.22. Early mortality: 3.6%. Significant improvement in left ventricular ejection fraction (LVEF) post-operatively.
- Mean follow-up: 21.8 months. Mid-term survival: 97.6%. Freedom from cardiac events: 89.7%.
- Symptomatic relief achieved in most patients, with 32.6% remaining in NYHA class III.
Conclusions:
- Off-pump coronary bypass is effective for patients with ischemic cardiomyopathy and no bypassable circumflex lesion.
- The procedure yields favorable early and mid-term results in this high-risk group.
- Supports the use of off-pump techniques for selected patients with severe left ventricular dysfunction.
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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