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Published on: March 27, 2018
Myocardial revascularization using on-pump beating heart among patients with left ventricular dysfunction
Ahmad K Darwazah1, Vivian Bader, Ismail Isleem
1Department of Cardiac Surgery, Makassed Hospital, Jerusalem, Israel. darwaz30@hotmail.com
Insights
The on-pump beating heart technique offers better myocardial revascularization in patients with low ejection fraction but is associated with increased morbidity. This on-pump beating heart (ONCAB/BH) approach shows promise despite higher complication rates compared to off-pump coronary artery bypass (OPCAB).
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.
Objectives:
On-pump beating heart technique for myocardial revascularization has been used successfully among both low and high risk patients. Its application among low ejection fraction patients is limited. The aim of our study is to evaluate this technique among patients with low ejection fraction and to compare results with off-pump bypass technique.
Methods:
This retrospective study includes 137 patients with ejection fraction below 0.35 who underwent isolated coronary artery bypass surgery. 39 patients underwent myocardial revascularization using on-pump beating heart (ONCAB/BH), while 98 patients had off-pump beating heart (OPCAB). Different preoperative, operative and postoperative variables were evaluated among both groups.
Results:
Patients profiles and risk factors were similar among both groups, except for the number of patients undergoing redo CABG which was significantly higher among ONCAB/BH (13% vs 3%; p = 0.025). Ejection fraction (EF) varied from 10-34%. The mean EF for patients who underwent ONCAB/BH was 28 ± 6 in comparison to 26 ± 5 for OPCAB patients (P = 0.093). Predicted risk for surgery according to EuroSCORE was similar among both groups (P = 0.443). The number of grafts performed per patient was significantly more among patients who underwent ONCAB/BH (2.2 ± 0.7 Vs 1.7 ± 0.7; P = 0.002). Completeness of revascularization was significantly greater in the ONCAB/BH patients (72% Vs 46%, P = 0.015). The incidence of hospital mortality and combined major morbidity was more among ONCAB/BH in comparison to OPCAB, but the difference was not significant. However, the incidence of blood loss, ventricular arrhythmias, inotropic support, ICU, hospital stay and blood transfusion were significantly greater among patients who underwent ONCAB/BH.
Conclusions:
On-pump beating heart technique can be used in myocardial revascularization among patients with left ventricular dysfunction. The technique was found to be associated with better myocardial revascularization when compared with OPCAB technique. However, the incidence of morbidity and mortality was more than OPCAB.
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