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Does off-pump coronary artery revascularization improve the long-term survival in patients with ventricular

Saina Attaran1, Matthew Shaw, Laura Bond

  • 1Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool L14 3PE, UK. saina.attaran@kcl.ac.uk

Interactive Cardiovascular and Thoracic Surgery
|July 13, 2010
PubMed

Insights

Off-pump coronary artery bypass grafting (OPCAB) offers shorter recovery but does not significantly improve survival rates compared to on-pump coronary artery bypass grafting (ONCAB) in patients with poor left ventricular function.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Left Ventricular Dysfunction

Background:

  • On-pump coronary artery bypass grafting (ONCAB) poses risks for patients with ejection fraction <30%.
  • Off-pump coronary artery bypass grafting (OPCAB) is proposed as a safer alternative, but long-term survival data are limited.
  • This study compares ONCAB and OPCAB outcomes in patients with severely impaired left ventricular function.

Purpose of the Study:

  • To assess the effect of cardiopulmonary bypass on patients with poor left ventricular function.
  • To compare mid- and long-term survival rates between ONCAB and OPCAB.
  • To evaluate postoperative complications and resource utilization in both groups.

Main Methods:

  • A 10-year retrospective study of 934 patients with ejection fraction <30% undergoing isolated first-time coronary artery bypass graft.
  • Patients were divided into ONCAB (n=528) and OPCAB (n=406) groups.
  • Outcomes including complications, mortality, and survival rates were compared after adjusting for preoperative characteristics.

Main Results:

  • OPCAB patients had shorter intensive care unit and hospital stays, and lower wound infection rates.
  • Postoperative complications, including stroke and perioperative myocardial infarction (MI), were comparable, with MI lower in OPCAB.
  • In-hospital mortality, mid-term (5-year), and long-term (10-year) survival rates were similar between groups, despite a higher re-intervention rate in OPCAB.

Conclusions:

  • OPCAB does not significantly improve in-hospital mortality or long-term survival compared to ONCAB in patients with left ventricular dysfunction.
  • Similar outcomes are achievable with adequate myocardial protection during ONCAB and complete revascularization during OPCAB.
  • While OPCAB offers some short-term benefits, long-term survival remains comparable between the two techniques.
Abstract

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