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Published on: March 27, 2018
Off-pump versus on-pump coronary artery bypass graft surgery outcomes in patients with severe left ventricle
Ali Sheikhy1,2, Aida Fallahzadeh1,2, Khalil Forouzannia3
1Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Off-pump coronary artery bypass grafting (OPCABG) showed lower 30-day mortality compared to on-pump (ONCABG) in high-risk patients. Mid-term outcomes were similar between OPCABG and ONCABG, suggesting comparable effectiveness for coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- High-Risk Cardiac Procedures
Background:
- Patients with low ejection fraction (EF < 35%) represent a high-risk group for coronary artery bypass grafting (CABG).
- Comparing on-pump (ONCABG) and off-pump (OPCABG) techniques is crucial for optimizing outcomes in this vulnerable population.
Purpose of the Study:
- To compare the mid-term cardiovascular events and all-cause mortality between OPCABG and ONCABG in patients with severe left ventricular dysfunction (EF < 35%).
Main Methods:
- A registry-based study included 2055 patients with EF ≤ 35% who underwent isolated CABG between 2014-2016.
- Propensity score weighting was employed to compare outcomes between the OPCABG (n=350) and ONCABG (n=1705) groups, with a median follow-up of 47.83 months.
Main Results:
- OPCABG demonstrated a significantly lower risk of 30-day mortality (OR: 0.021).
- No significant differences were observed in mid-term mortality (HR: 0.822) or non-fatal cardiovascular events (HR: 1.246) between OPCABG and ONCABG.
- Patients with >3 traditional risk factors showed improved mid-term mortality with OPCABG (HR: 0.420).
Conclusions:
- OPCABG is associated with reduced short-term mortality in high-risk CABG patients.
- Mid-term efficacy in terms of mortality and cardiovascular events is comparable between OPCABG and ONCABG techniques.
Objective:
In this study we aimed to compare on-pump and off-pump coronary artery bypass grafting (CABG) outcomes in patients presented with low left ventricular ejection fraction (EF) as a high-risk group of patients.
Methods:
In this registry-based study from 2014 and 2016, all patients with severe left ventricular dysfunction (EF less than 35%) were included and followed until 2020. The median follow-up period was 47.83 [38.41, 55.19] months. Off pump CABG (OPCABG) was compared with on-pump CABG (ONCABG) in terms of mid-term non-fatal cardiovascular events (CVEs) and all-cause mortality. Propensity score method (with inverse probability weighting technique) was used to compare these two groups.
Results:
From 14,237 patients who underwent isolated CABG, 2055 patients with EF ≤ 35% were included; 1705 in ONCABG and 350 patients in OPCABG groups. Although OPCABG was associated with lower risk of 30-days mortality (Odds Ratio [OR]: 0.021; Confidence Interval [CI] 95% [0.01, 0.05], P < 0.001); there was no significant difference between OPCABG and ONCABG in term of mid-term mortality and non-fatal CVEs ((Hazard ratio [HR]: 0.822; 95%CI [0.605, 1.112], p = 0.208) and (HR: 1.246; 95%CI [0.805, 1.929], p = 0.324), respectively). Patients with more than three traditional coronary artery disease risk factors, had more favorable outcomes (in terms of mid-term mortality) if underwent OPCABG (HR: 0.420; 95%CI [0.178, 0.992], p = 0.048).
Conclusion:
OPCABG was associated with lower risk of 30-days mortality; however, mid-term outcomes were comparable in both OPCABG and ONCABG techniques.
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