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Off-pump coronary artery bypass in severe left ventricular dysfunction.

Shantanu Pande1, Surendra K Agarwal, Anirban Kundu

  • 1Department of Cardiovascular and Thoracic Surgery, Lucknow 226014, UP, India. spande@sgpgi.ac.in

Asian Cardiovascular & Thoracic Annals
|June 12, 2009
PubMed
Summary

Off-pump coronary artery bypass grafting improved ejection fraction in patients with severe left ventricular dysfunction. However, outcomes differed based on initial ejection fraction, with better results in those with 26%-35% function.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Research

Background:

  • Severe left ventricular dysfunction poses challenges for cardiac surgery.
  • Off-pump coronary artery bypass grafting (OPCAB) is a surgical option for these patients.
  • Understanding outcomes based on ejection fraction is crucial for patient selection and management.

Purpose of the Study:

  • To evaluate the outcomes of multivessel off-pump coronary artery bypass grafting in patients with severe left ventricular dysfunction (ejection fraction ≤35%).
  • To compare the results between patients with ejection fraction ≤25% and those with ejection fraction 26%-35%.

Main Methods:

  • A consecutive series of 58 patients with ejection fraction ≤35% undergoing multivessel OPCAB were studied.
  • Patients were divided into two groups based on preoperative ejection fraction: ≤25% (Group 1) and 26%-35% (Group 2).
  • Follow-up was conducted for a median of 15 months, assessing left ventricular dimensions, ejection fraction, and mitral regurgitation.

Main Results:

  • Group 2 (EF 26%-35%) showed greater improvement in ejection fraction (33%) compared to Group 1 (EF ≤25%) (10%).
  • Left ventricular dimensions increased postoperatively in Group 1, while regression was observed in Group 2.
  • Mitral regurgitation improved in Group 2 but progressed in Group 1.
  • Lower ejection fraction predicted increased need for intraaortic balloon pumping, longer inotropic support, higher pulmonary-to-systemic pressure ratio, and greater postoperative drainage.

Conclusions:

  • Multivessel OPCAB can improve cardiac function in selected patients with severe left ventricular dysfunction.
  • Patients with ejection fraction between 26%-35% experience more favorable left ventricular remodeling and functional improvement compared to those with ejection fraction ≤25%.
  • Preoperative ejection fraction is a significant predictor of perioperative outcomes and resource utilization in this patient cohort.