Off-pump coronary artery bypass in severe left ventricular dysfunction

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.