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Updated: Jul 1, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Long-term results following off-pump coronary-artery bypass grafting in left ventricular dysfunction
Masahiro Ikeda1, Hiroshi Niinami2, Kozo Morita2
1Department of Cardiovascular Surgery, Tokyo Women's Medical University Hospital, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan. ikeda.masahiro@twmu.ac.jp.
Insights
Off-pump coronary-artery bypass grafting (CABG) with bilateral internal thoracic artery (BITA) grafting improves outcomes in patients with severe left ventricular (LV) dysfunction. Long-term benefits were limited in patients with persistent low LV ejection fraction or on hemodialysis.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Revascularization
Background:
- Severe left ventricular (LV) dysfunction is a significant risk factor for mortality post-coronary-artery bypass grafting (CABG).
- Off-pump CABG (OPCAB) and bilateral internal thoracic artery (BITA) grafting are associated with reduced complications and improved long-term survival.
Purpose of the Study:
- To evaluate the impact of multivessel OPCAB using BITA grafting for complete revascularization on postoperative and long-term outcomes.
- Focus on patients with severely impaired LV ejection fraction (EF) ≤ 30.0%.
Main Methods:
- Retrospective analysis of 121 patients with EF ≤ 30.0% undergoing isolated multivessel OPCAB (April 2007 - December 2019).
- Comparison between patients receiving BITA grafts (n=66) and single internal thoracic artery (SITA) grafts (n=55).
- Multivariate analysis to identify predictors of late mortality and cardiac events.
Main Results:
- Low in-hospital mortality (1.65%) with significant early postoperative LV ejection fraction (LVEF) improvement in 75.2% of patients.
- BITA grafting was associated with reduced cardiac death and events compared to SITA grafting.
- Persistent LVEF ≤ 30.0% postoperatively and lack of BITA grafting were significant predictors of adverse cardiac outcomes; hemodialysis predicted all-cause mortality.
Conclusions:
- Multivessel OPCAB with BITA grafting offers acceptable early outcomes and potential long-term benefits for patients with severe LV dysfunction.
- Long-term benefits are significantly diminished in patients with persistent low LVEF or requiring chronic hemodialysis.
- Complete revascularization via OPCAB and BITA grafting is a viable strategy for selected high-risk cardiac patients.
Abstract:
Severe left ventricular (LV) dysfunction is an independent risk factor for early and long-term mortality after coronary-artery bypass grafting (CABG). Off-pump CABG (OPCAB) significantly reduces the early incidence of major complications in high-risk patients. Moreover, bilateral internal thoracic artery (BITA) grafting after CABG is associated with improved long-term outcomes. We aimed to evaluate the impact of multivessel OPCAB with BITA grafting for complete revascularization on postoperative and long-term outcomes in patients with low LV ejection fraction (EF). We included 121 patients with EF ≤ 30.0% who underwent isolated multivessel OPCAB (average LVEF, 24.8%) between April 2007 and December 2019. Sixty-six patients received BITA grafts, while 55 had single internal thoracic artery (SITA) grafts. We conducted multivariate analyses to examine the correlation between perioperative data and late mortality rate. The early mortality rate was 1.65%. After excluding in-hospital mortality cases, we performed long-term follow-up of 119 patients. Early postoperative echocardiography showed significant LVEF improvement in 89 (75.2%) patients. However, LVEF remained ≤ 30.0% in 30 (24.8%) patients. We recorded 15 and 30 cases of cardiac death and cardiac events, respectively, during the long-term follow-up period. Postoperative LVEF ≤ 30.0% (P < 0.01) and no use of BITA grafting (P = 0.03) were significant predictors of cardiac death and events; moreover, hemodialysis was a significant predictor of all-cause mortality rather than cardiac death. Multivessel OPCAB in patients with severe LV dysfunction was associated with acceptable in-hospital mortality and early postoperative improvement in LV function. Additionally, OPCAB with BITA grafting may provide long-term benefits with respect to cardiac death and events. However, the long-term benefits were significantly limited in patients without early postoperative improvement in LV function and patients with chronic hemodialysis.Clinical registration number: 5590 (14/5/2020 Tokyo Women's Medical University).
