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Updated: Nov 18, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Off-pump coronary artery bypass grafting for patients with severely reduced ventricular function-A justified
Anneke Neumann1,2, Lina Serna-Higuita3, Hendrik Detzel1
1Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Insights
Off-pump coronary artery bypass grafting (OPCAB) is a safe and effective surgical option for patients with reduced ejection fraction (EF), showing comparable outcomes to conventional CABG (ONCAB) without compromising revascularization or increasing re-intervention rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Thoracic Surgery
Background:
- Reduced ejection fraction (EF) is a significant risk factor for adverse outcomes following coronary artery bypass grafting (CABG).
- Comparing off-pump CABG (OPCAB) with conventional CABG (ONCAB) in patients with low EF is crucial for optimizing surgical strategy.
Purpose of the Study:
- To compare the efficacy and early to midterm outcomes of OPCAB versus ONCAB in patients with reduced left ventricular ejection fraction (LV-EF ≤35%).
Main Methods:
- Retrospective review of 111 patients with LV-EF ≤35% undergoing CABG between 2015-2017.
- Propensity score matching and multivariate logistic regression were employed to adjust for baseline differences.
- Outcomes assessed included mortality, re-sternotomies, blood transfusions, low cardiac output syndrome, delirium, revascularization completeness, and survival.
Main Results:
- No significant difference in early mortality between OPCAB and ONCAB groups.
- OPCAB was associated with significantly fewer re-sternotomies for bleeding and less need for blood transfusions.
- OPCAB patients showed a trend towards less low cardiac output syndrome and postoperative delirium.
- Completeness of revascularization and survival rates at 6 months, 1 year, and 3 years were similar between groups.
- Fewer ONCAB patients required coronary re-intervention during follow-up.
Conclusions:
- Off-pump CABG (OPCAB) is a safe and effective surgical approach for patients with reduced ejection fraction.
- OPCAB does not compromise the completeness of revascularization or lead to increased coronary re-interventions in the early follow-up period.
- These findings support OPCAB as a viable alternative to ONCAB for selected patients with compromised cardiac function.
Background And Aim:
Low ejection fraction (EF) has been identified as a main risk factor for perioperative complications and mortality after coronary artery bypass grafting (CABG). The purpose of this study was to compare the efficacy and early as well as midterm outcomes of off-pump CABG (OPCAB) and conventional CABG (ONCAB) surgery in patients with reduced EF.
Methods:
We performed a retrospective review of patient demographics, preoperative risk factors, operative and postoperative outcomes of patients with left ventricular EF (LV-EF) ≤35%, who underwent CABG at our institution between January 2015 and December 2017. Propensity score and multivariate logistic regression analysis were used to compare risk adjusted outcomes between groups.
Results:
Overall, 111 consecutive CABG-patients with LV-EF ≤ 35% underwent either ONCAB (46 patients, 41.4%) or OPCAB surgery (65 patients, 58.6%). There was no difference in early mortality (5% vs. 7.5%, p = .64) between groups. After propensity score matching, OPCAB-patients required significantly less re-sternotomies for bleeding (20% vs. 2.5%, p = .03) and consequently received significantly less blood transfusions (57.5% vs. 32.5%, p = .03). Fewer OPCAB-patients experienced low cardiac output syndrome (22.5% vs. 42.5%, p = .06) and suffered from postoperative delirium (22.5% vs. 42.5%, p = .06). There were no differences in completeness of revascularization between groups (median 1 (1.0-1.33; 1.0-1.33) OPCAB versus median 1 (1-1.33; 0.67-2) ONCAB, p = .95). Survival after 6 months, one year and three years was similar for ONCAB- and OPCAB-patients (ONCAB 92.3%, 89.4%, and 89.4% vs. OPCAB 89.8%, 85.7%, and 82.1%; p = .403). More ONCAB-patients needed a coronary re-intervention during follow-up (8.6% vs. 2.3%, p = .402).
Conclusion:
OPCAB-surgery is a safe and effective option for patients with reduced EF. Furthermore, it does not come at the expense of less complete revascularization or increased coronary re-intervention during early follow-up.
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