Early and Long-Term Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction and a Giant Left Ventricle
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Published on: March 27, 2018
Chen Wang1, Yefan Jiang1,2, Qingpeng Wang1
1Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
Insights
Off-pump coronary artery bypass grafting (OPCAB) in patients with severe left ventricular dysfunction and a giant left ventricle showed fewer early complications but a higher rate of incomplete revascularization than on-pump CABG (ONCAB). Long-term survival was similar, but OPCAB had fewer major adverse cardiovascular events.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Revascularization
Background:
- Severe left ventricular dysfunction (LVD) and giant left ventricle pose unique challenges in coronary artery bypass grafting (CABG).
- Comparative outcomes between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) in this specific high-risk patient population remain understudied.
Purpose of the Study:
- To compare the clinical outcomes of OPCAB versus ONCAB in patients with severe LVD and a giant left ventricle.
- To determine the safety and efficacy of OPCAB in this challenging cohort.
Main Methods:
- Retrospective analysis of 98 patients undergoing isolated CABG (46 ONCAB, 52 OPCAB) between 2011-2021.
- Propensity score matching was employed to balance baseline characteristics between the ONCAB and OPCAB groups.
Main Results:
- After matching, OPCAB had a higher rate of incomplete revascularization (25.0% vs. 9.1%) but lower rates of postoperative IABP usage (9.1% vs. 25.0%) and renal insufficiency (11.4% vs. 29.5%).
- Thirty-day mortality was identical (4.5% vs. 4.5%).
- Long-term survival was similar, yet OPCAB demonstrated a lower probability of major adverse cardiovascular events (MACE).
Conclusions:
- OPCAB in patients with severe LVD and a giant left ventricle is associated with reduced early postoperative complications compared to ONCAB.
- While OPCAB may compromise long-term quality of life due to incomplete revascularization, it offers a survival benefit regarding MACE.
Introduction:
No previous studies comparing the outcomes between off-pump coronary artery bypass grafting (off-pump CABG, OPCAB) and on-pump CABG (ONCAB) have been performed in patients with severe left ventricular dysfunction (LVD) and a giant left ventricle. We aimed to investigate whether such patients could benefit from OPCAB.
Methods:
From January 2011 to January 2021, a total of 98 patients with severe LVD and a giant left ventricle underwent isolated CABG (ONCAB 46, OPCAB 52) in Wuhan Union Hospital. The clinical data were collected retrospectively and propensity score matching was performed to adjust baseline characteristics.
Results:
After propensity matching, the two groups were comparable in baseline variables. The OPCAB group had a higher rate of incomplete revascularization than the ONCAB group (25.0% vs. 9.1%; p = 0.047). The 30-day mortality was similar between the matched groups (4.5% vs. 4.5%; p = 1.000) but the OPCAB group had a lower risk of postoperative IABP usage (9.1% vs. 25.0%; p = 0.047) and renal insufficiency (11.4% vs. 29.5%; p = 0.034). The long-term probability of survival (log-rank test, p = 0.450) was similar between the two groups but the OPCAB group had a lower probability of major adverse cardiovascular events (log-rank test, p = 0.038).
Conclusions:
For patients with severe LVD and a giant left ventricle, OPCAB reduced early postoperative complications while sacrificing long-term quality of life compared to those having ONCAB.
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