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On- vs. Off-Pump CABG in Heart Failure Patients with Reduced Ejection Fraction (HFrEF): A Multicenter Analysis
Christian Jörg Rustenbach1, Stefan Reichert1, Medhat Radwan1
1Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany.
Insights
Off-pump coronary artery bypass grafting (OPCAB) offers improved postoperative outcomes for patients with reduced ejection fraction compared to on-pump coronary artery bypass grafting (ONCAB). Both methods show similar 30-day mortality, but OPCAB reduces ventilation time and ICU stay.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Reduced ejection fraction (<40%) poses challenges in coronary artery bypass grafting (CABG).
- Comparing on-pump (ONCAB) and off-pump (OPCAB) techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare postoperative outcomes and 30-day mortality between ONCAB and OPCAB in patients with reduced ejection fraction.
- To evaluate the safety and efficacy of OPCAB as an alternative to ONCAB in this high-risk group.
Main Methods:
- Retrospective analysis of 551 patients undergoing isolated CABG from January 2017 to December 2021 across four German university hospitals.
- Comparison of demographic, intraoperative, and postoperative data between ONCAB and OPCAB groups.
- Inclusion of patients with reduced ejection fraction (<40%).
Main Results:
- No demographic differences were observed; however, OPCAB patients had higher rates of preoperative renal insufficiency and urgency.
- ONCAB group achieved higher complete revascularization rates, while OPCAB required fewer transfusions.
- No significant difference in 30-day/in-hospital mortality between ONCAB and OPCAB groups.
- OPCAB group showed significantly shorter mechanical ventilation, reduced ICU stay, and lower incidence of ECLS, AKI, delirium, and sepsis.
Conclusions:
- OPCAB surgery is a safe and effective alternative to ONCAB for patients with reduced ejection fraction.
- OPCAB offers improved postoperative recovery, including shorter ventilation and ICU duration, with comparable mortality.
- These findings support OPCAB as a beneficial approach for patients with coronary heart disease and reduced ejection fraction.
Objective:
This study aimed to compare postoperative outcomes and 30-day mortality in patients with reduced ejection fraction (<40%) who underwent isolated coronary artery bypass grafting (CABG) with (ONCAB) and without (OPCAB) the use of cardiopulmonary bypass.
Methods:
data from four university hospitals in Germany, spanning from January 2017 to December 2021, were retrospectively analyzed. A total of 551 patients were included in the study, and various demographic, intraoperative, and postoperative data were compared.
Results:
demographic parameters did not exhibit any differences. However, the OPCAB group displayed notably higher rates of preoperative renal insufficiency, urgent surgeries, and elevated EuroScore II and STS score. During surgery, the ONCAB group showed a significantly higher rate of complete revascularization, whereas the OPCAB group required fewer intraoperative transfusions. No disparities were observed in 30-day/in-hospital mortality for the entire cohort and the matched population between the two groups. Subsequent to surgery, the OPCAB group demonstrated significantly shorter mechanical ventilation times, reduced stays in the intensive care unit, and lower occurrences of ECLS therapy, acute kidney injury, delirium, and sepsis.
Conclusions:
the study's findings indicate that OPCAB surgery presents a safe and viable alternative, yielding improved postoperative outcomes in this specific patient population compared to ONCAB surgery. Despite comparable 30-day/in-hospital mortality rates, OPCAB patients enjoyed advantages such as decreased mechanical ventilation durations, shorter ICU stays, and reduced incidences of ECLS therapy, acute kidney injury, delirium, and sepsis. These results underscore the potential benefits of employing OPCAB as a treatment approach for patients with coronary heart disease and reduced ejection fraction.
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