Off-pump Coronary Bypass Surgery in Patients With Low Ejection Fraction: Is There a Long-Term Survival Advantage?

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Minimally Invasive Cardiac Surgery

Background:

• Patients with low ejection fraction (≤30%) represent a high-risk group for coronary artery bypass surgery.
• Off-pump coronary artery bypass surgery (OPCAB) aims to reduce surgical trauma compared to traditional on-pump coronary artery bypass surgery (ONCAB).

Purpose of the Study:

• To investigate the long-term survival rates of patients with low ejection fraction undergoing OPCAB.
• To compare the outcomes of OPCAB with historical ONCAB data and literature data for percutaneous coronary intervention and OPCAB.

Main Methods:

• A cohort of 346 patients with ejection fraction ≤30% who underwent isolated OPCAB was analyzed.
• Propensity score matching was used to compare OPCAB patients with a historical ONCAB group.
• Outcomes were also compared with available literature data for percutaneous coronary intervention and OPCAB in high-risk populations.

Main Results:

• OPCAB demonstrated significantly better 30-day survival, shorter hospital stays, and fewer in-hospital complications due to its lower invasiveness.
• Incomplete revascularization, particularly of posterior and lateral heart territories, was associated with increased 1-year mortality.
• Eight-year survival probability was 50.1% for OPCAB versus 49.7% for ONCAB, with no significant long-term survival advantage observed.

Conclusions:

• Off-pump coronary artery bypass surgery (OPCAB) is a feasible alternative for patients with low ejection fraction.
• Currently, OPCAB does not show a demonstrable long-term survival advantage over on-pump coronary artery bypass surgery (ONCAB) in this high-risk patient group.