Related Experiment Video
Updated: Oct 24, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Off-pump coronary artery bypass grafting is safe and effective in patients with severe left ventricular dysfunction
Mateo Marin-Cuartas1, Salil V Deo2, Paulina Ramirez1
1University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
Insights
Off-pump coronary artery bypass grafting (OPCAB) is safe for patients with severe left ventricular dysfunction (LVD). Outcomes, including long-term mortality, were similar between OPCAB and conventional CABG (ONCAB) despite more incomplete revascularization with OPCAB.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Left Ventricular Dysfunction Management
Background:
- Severe left ventricular dysfunction (LVD) increases risks associated with coronary artery bypass grafting (CABG).
- Limited data exist comparing coronary artery bypass grafting (CABG) techniques in patients with severe LVD.
Purpose of the Study:
- To compare the early and long-term outcomes of off-pump coronary artery bypass grafting (OPCAB) versus conventional coronary artery bypass grafting (ONCAB) in patients with severe LVD.
- To evaluate the safety and efficacy of OPCAB in this high-risk patient population.
Main Methods:
- Retrospective, single-center, propensity-matched analysis of 1161 patients with severe LVD undergoing isolated CABG between 2002 and 2014.
- Comparison of early outcomes (30-day mortality, hospital stay, transfusion rates) and long-term outcomes (all-cause mortality, survival rates) between OPCAB and ONCAB groups.
- Primary outcome: long-term all-cause mortality.
Main Results:
- Incomplete revascularization occurred more frequently in the OPCAB group (35.3%) compared to the ONCAB group (21.6%).
- 30-day mortality was comparable (5% overall) between matched OPCAB and ONCAB groups.
- OPCAB was associated with shorter hospital stays and lower packed red blood cell transfusion rates.
- Estimated 10-year survival rates were 59.9% for OPCAB and 49.1% for ONCAB (P=0.99), with no significant difference in long-term mortality (HR 0.94; P=0.7).
Conclusions:
- Off-pump coronary artery bypass grafting (OPCAB) is a safe and effective surgical option for patients with severe left ventricular dysfunction (LVD).
- While incomplete revascularization is more common with OPCAB, it does not appear to impact long-term mortality in this patient cohort.
- The study supports the use of OPCAB in selected patients with severe LVD, offering comparable long-term survival benefits to ONCAB.
Objectives:
Severe left ventricular dysfunction (LVD) is associated with increased risk following coronary artery bypass grafting (CABG). Due to a dearth of reports on the choice of CABG technique in patients with LVD, this study aims to compare the outcomes of off-pump CABG (OPCAB) and conventional CABG (ONCAB) in such patients.
Methods:
Retrospective single-centre propensity-matched analysis comparing early- and long-term outcomes of OPCAB and ONCAB in patients with severe LVD. Primary outcome was long-term all-cause mortality.
Results:
Between 2002 and 2014, a total of 1161 consecutive patients with severe LVD underwent isolated CABG [442 patients underwent OPCAB and 719 ONCAB (430 matched pairs)]. Incomplete revascularization was observed more frequently among OPCAB than ONCAB patients (35.3% vs 21.6%; P < 0.01). The overall 30-day mortality was 5% and was comparable between the matched groups [OR 0.64 (0.34-1.22); P = 0.18]. OPCAB patients had shorter median hospital stay (11 vs 12 days; P = 0.02) and lower packed red blood cell transfusion rates [2.7 (2.21-3.19) vs 4.4 (3.56-5.24); P < 0.01]. Estimated adjusted survival was 86.0% vs 85.8%, 69.1% vs 65.5% and 59.9% vs 49.1% at 1, 5 and 10 years for OPCAB and ONCAB patients, respectively (P = 0.99). Long-term risk of mortality was similar between groups [hazard ratio (HR) 0.94 (0.66-1.32); P = 0.7]. Incomplete revascularization was weakly associated with increased risk of long-term all-cause mortality [HR 1.33 (0.99-1.77); P = 0.05].
Conclusions:
OPCAB is safe and effective in patients with severe LVD. Although incomplete revascularization is more commonly observed in patients undergoing OPCAB, it is not associated with increased late mortality.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
Published on: April 24, 2017
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:29Cardiomyopathy V: Interprofessional Care