Myocardial revascularization using on-pump beating heart among patients with left ventricular dysfunction

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Cardiology

Background:

• The on-pump beating heart (ONCAB/BH) technique is established for myocardial revascularization but its use in patients with low ejection fraction (EF) is less explored.
• Patients with reduced left ventricular function pose unique challenges for cardiac surgical procedures.

Purpose of the Study:

• To evaluate the efficacy and safety of the on-pump beating heart technique in patients with ejection fraction below 0.35.
• To compare the outcomes of ONCAB/BH with the off-pump beating heart (OPCAB) technique in this specific patient cohort.

Main Methods:

• Retrospective analysis of 137 patients with EF < 0.35 undergoing isolated coronary artery bypass surgery.
• Comparison between 39 patients in the ONCAB/BH group and 98 patients in the OPCAB group.
• Evaluation of preoperative, operative, and postoperative variables, including graft success and complications.

Main Results:

• ONCAB/BH group had more redo CABG cases (13% vs 3%).
• Greater completeness of revascularization (72% vs 46%) and more grafts per patient (2.2 vs 1.7) in the ONCAB/BH group.
• Higher incidence of blood loss, arrhythmias, inotropic support, and longer ICU/hospital stays in the ONCAB/BH group, though mortality and major morbidity were not significantly different.

Conclusions:

• On-pump beating heart technique is feasible for myocardial revascularization in patients with left ventricular dysfunction.
• The ONCAB/BH technique provides superior myocardial revascularization compared to OPCAB.
• Increased morbidity necessitates careful consideration when selecting the ONCAB/BH approach for these high-risk patients.