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Updated: Jun 3, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
The influence of a low ejection fraction on long-term survival in systematic off-pump coronary artery bypass surgery
Simon Maltais1, Martin Ladouceur, Raymond Cartier
1Department of Cardiovascular Surgery, Montreal Heart Institute/Université de Montréal, Montreal, Quebec, Canada.
Insights
Off-pump coronary artery bypass surgery is safe for patients with poor left-ventricular ejection fraction (EF). While long-term survival is reduced, major adverse cardiac events are comparable to those with better EF.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Poor left-ventricular ejection fraction (EF) presents significant risks for coronary artery bypass surgery.
- Off-pump coronary artery bypass (OPCAB) surgery is a strategy for myocardial revascularization in patients with reduced EF.
- Limited long-term data exists for OPCAB in patients with severely impaired EF.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of OPCAB surgery in patients with left-ventricular EF ≤ 35%.
- To compare survival and adverse cardiac event rates between patients with poor EF and those with EF >35% undergoing OPCAB.
Main Methods:
- Prospective follow-up of 137 patients with preoperative left-ventricular EF ≤ 35% who underwent OPCAB surgery between 1996 and 2006.
- Comparison of outcomes with a larger cohort of 1250 OPCAB patients.
- Follow-up data collected for a mean of 66 months, with 97% patient compliance.
Main Results:
- Ten-year survival was significantly lower in the poor EF group (44% vs 76%).
- Freedom from cardiac death was significantly reduced in patients with EF ≤ 35%.
- After risk factor adjustment, freedom from major adverse cardiac events was comparable between groups.
Conclusions:
- Off-pump coronary artery bypass surgery is a feasible and safe option for patients with poor left-ventricular EF.
- Despite comparable freedom from major adverse events, patients with reduced EF experience decreased overall and cardiac survival post-OPCAB.
Objective:
Poor left-ventricular ejection fraction (EF) is a recognized operative and long-term risk factor in coronary artery bypass surgery. Over the past decade, off-pump coronary artery bypass surgery has emerged as a new strategy to address myocardial revascularization in poor left-ventricular EF patients, but few reports have documented long-term results. The aim of this study was to investigate long-term clinical results in off-pump coronary artery bypass patients with ≤ 35% left-ventricular EF.
Methods:
From September 1996 to May 2006, 1250 patients underwent off-pump coronary artery bypass revascularization, and were prospectively followed-up at the Montreal Heart Institute. Among them, 137 patients (pts) had a preoperative left-ventricular EF ≤ 35%. Follow-up was completed in 97% of patients.
Results:
Mean follow-up was 66 ± 34 months. Rate of grafts per pts was comparable in both groups. Overall 30-day mortality was 1.7% (1.5% EF >35% pts vs 2.9% in EF ≤ 35% pts; p = 0.19). Ten-year survival was lower in poor EF patients (44 ± 7% vs 76 ± 2%), and remained significant even after adjusting for risk factors (p = 0.04). Freedom from cardiac death for both groups was also significantly reduced in poor EF patients (p = 0.008). After adjustment, freedom from the combined end point of cardiac or sudden death, myocardial infarction, repeat coronary revascularization, unstable angina, and cardiac failure was comparable in both groups (p = 0.5).
Conclusions:
Off-pump coronary artery bypass surgery can be performed adequately and safely in poor EF patients. However, overall and cardiac survival was decreased in this subset of patients with a comparable freedom from major cardiac adverse related events.
