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Published on: March 27, 2018
Off-pump coronary artery bypass surgery lacks a longitudinal survival advantage in patients with left ventricular
Laura Seese1, Ibrahim Sultan1, Yisi Wang1
1Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Off-pump coronary artery bypass (OPCAB) surgery showed similar 1-year survival but lower 5-year survival compared to on-pump coronary artery bypass (ONCAB) in patients with reduced left ventricular ejection fraction (LVEF). Further research is needed to understand factors influencing long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Heart Failure Management
Background:
- Patients with reduced left ventricular ejection fraction (LVEF ≤ 30%) present unique challenges for coronary artery bypass grafting.
- Off-pump coronary artery bypass (OPCAB) surgery aims to avoid cardiopulmonary bypass, potentially offering benefits in high-risk populations.
- The long-term efficacy of OPCAB versus on-pump coronary artery bypass (ONCAB) in patients with severely impaired LVEF remains an area of investigation.
Purpose of the Study:
- To evaluate the longitudinal impacts of OPCAB surgery compared to ONCAB in patients with significantly reduced left ventricular ejection fraction (LVEF).
- To assess differences in survival, hospital readmissions, and postoperative morbidities between OPCAB and ONCAB in this specific patient cohort.
Main Methods:
- Retrospective analysis of 660 adult patients with LVEF ≤ 30% who underwent coronary artery bypass grafting between 2011 and 2020.
- Patients were categorized into OPCAB and ONCAB groups.
- Propensity score matching and multivariable regression were employed to analyze risk-adjusted mortality, readmissions, and postoperative complications.
Main Results:
- Complete revascularization rates were comparable between OPCAB and ONCAB groups (80.3% vs. 82.0%).
- While 1-year survival was similar (86.8% vs. 85.7% in matched cohort), 5-year survival was significantly lower for OPCAB patients compared to ONCAB patients (64.1% vs. 69.9%).
- Hospital readmission rates, including cardiac-related and heart failure events, were similar between the two surgical approaches.
Conclusions:
- In contemporary patients with reduced LVEF, OPCAB surgery is associated with similar short-term survival but inferior long-term survival at 5 years compared to ONCAB.
- The findings suggest that factors beyond cardiopulmonary bypass utilization may influence long-term mortality in the low LVEF population undergoing coronary artery bypass grafting.
- Further investigation is warranted to elucidate the underlying mechanisms contributing to the observed survival disparity.
Background:
This study evaluates the longitudinal impacts of off-pump coronary artery bypass (OPCAB) surgery in patients with reduced left ventricular ejection fraction (LVEF).
Methods:
Adults with LVEF ≤ 30% undergoing coronary artery bypass grafting between 2011 and 2020 were included. Patients were stratified based on the utilization of cardiopulmonary bypass into OPCAB or on-pump coronary artery bypass (ONCAB) groups. Primary outcomes included survival and hospital readmissions. Secondary outcomes evaluated postoperative morbidities. Multivariable regression evaluated risk-adjusted mortality and readmission. Propensity score matching was utilized to reduce bias.
Results:
A total of 660 low LVEF patients were included, of which 28.5% (n = 188) were OPCAB and 71.5% (n = 472) were ONCAB. The rates of complete revascularization were similar between the groups (80.3% vs 82.0%; P = .67). Early survival between the unmatched groups was similar at 1-year follow-up (86.2% vs 87.9%; P = .53); however, at 5 years OPCABs had significantly worse survival compared with ONCABs (71.5% vs 64.2%; P = .02). These findings persisted in the matched cohort where survival at 1 year was comparable (86.8% vs 85.7%; P = .80), but 5-year survival was better for ONCABs (64.1% vs 69.9%; P = .03). The rates of readmission were similar between the unmatched and matched groups at all time intervals, including readmissions for cardiac-related and heart failure-related events (all, P > .05).
Conclusions:
In contemporary patients with reduced LVEF, survival after OPCAB was similar at 1 year but lower at 5-year follow-up compared with ONCAB, despite similar rates of complete revascularization. These findings suggest that there may be other factors influencing longitudinal mortality in the low LVEF cohort, beyond the use of cardiopulmonary bypass.
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