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Off-pump coronary artery bypass surgery in severe left ventricular dysfunction
Rasoul Azarfarin1, Leili Pourafkari, Rezayat Parvizi
1Cardiovascular Research Center, Madani Heart Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
Coronary artery bypass surgery outcomes differ for patients with left ventricular dysfunction. Off-pump surgery reduced complications in these patients, but not mortality.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Left Ventricular Dysfunction
Background:
- Left ventricular dysfunction is a significant risk factor in coronary artery bypass surgery.
- Understanding surgical technique impact (off-pump vs. on-pump) is crucial for patient outcomes.
Purpose of the Study:
- To compare hospital outcomes of coronary artery bypass grafting (CABG) in patients with and without left ventricular dysfunction.
- To evaluate the influence of surgical technique (off-pump vs. on-pump) on outcomes in these patient groups.
Main Methods:
- Prospective data collection on 689 isolated first-time CABG patients (March 2007-March 2008).
- Patients divided into two groups: ejection fraction <= 30% (Group 1, n=127) and >30% (Group 2, n=562).
- Analysis of preoperative risk profiles and hospital outcomes, including off-pump vs. on-pump surgery rates.
Main Results:
- Group 1 (ejection fraction <= 30%) had significantly higher infectious, neurologic, and cardiac complications.
- Low ejection fraction was an independent risk factor for complications and mortality.
- Off-pump surgery was associated with a lower rate of total complications in both groups compared to on-pump, but no significant mortality difference was observed.
Conclusions:
- Left ventricular dysfunction independently increases morbidity and mortality risk after coronary artery bypass surgery.
- Off-pump coronary artery bypass surgery may mitigate the increased morbidity associated with ventricular dysfunction.
- Further research may be needed to confirm mortality benefits of off-pump surgery in this population.
Abstract:
Our aim was to examine hospital outcomes of coronary artery bypass surgery in patients with and without left ventricular dysfunction, with regard to the surgical technique (off- or on-pump). Between March 2007 and March 2008, 689 consecutive patients underwent isolated first-time coronary artery bypass; 127 had ejection fractions < or = 30% (group 1) and 562 had ejection fractions >30% (group 2). Data of preoperative risk profiles and hospital outcomes were collected prospectively. Off-pump operations were performed in 49 (38.6%) patients in group 1 and 196 (34.9%) in group 2. The incidences of infectious, neurologic, and cardiac complications postoperatively were significantly higher in group 1. In multivariate analysis, preoperative ejection fraction < or = 30% was found to be an independent risk factor for postoperative complications and hospital mortality. The subgroup of patients undergoing off-pump surgery in both groups had a significantly lower rate of total complications than those undergoing conventional on-pump operations, but no significant difference in mortality was observed between those undergoing off-pump or conventional surgery in either group. Off-pump surgery helped to limit the increased morbidity rate after coronary bypass in patients with ventricular dysfunction.
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