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Coronary artery by-pass without cardiopulmonary by-pass for patients with severe left ventricular dysfunction
Y Moshkovitz1, L Sternik, H Hod
1Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) shows promising results for patients with severe left ventricular dysfunction. This approach may offer advantages for this high-risk patient group.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
Background:
- Severe left ventricular dysfunction (EF < 35%) presents significant challenges for cardiac surgery.
- Traditional cardiopulmonary bypass (CPB) may carry increased risks for these vulnerable patients.
Purpose of the Study:
- To evaluate the outcomes of coronary artery bypass grafting (CABG) performed without cardiopulmonary bypass (CPB).
- To assess the safety and efficacy of off-pump CABG in patients with severe left ventricular dysfunction.
Main Methods:
- A cohort of 53 patients with severe LV dysfunction (EF < 35%) underwent off-pump CABG between 1991 and 1993.
- The study included patients with preoperative low ejection fraction, cardiogenic shock, and those undergoing re-do CABG.
- Intra-arterial bypass grafting (IMA) was utilized in 77% of cases.
Main Results:
- Perioperative mortality was low at 1.9%, with a 3.7% rate of non-fatal myocardial infarction.
- At two-year follow-up, late mortality was 5.7%, with three patients experiencing angina requiring reoperation.
- The mean number of grafts per patient was 1.8.
Conclusions:
- Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) appears to be a viable and potentially advantageous option for patients with severe left ventricular dysfunction.
- Off-pump CABG may reduce perioperative complications in this high-risk population.
Objectives:
To evaluate results of coronary artery bypass grafting (CABG) without cardiopulmonary by-pass (CPB) for patients with severe left ventricular dysfunction.
Materials And Methods:
Fifty-three patients with severe LV dysfunction (EF < 35%) underwent CABG without cardiopulmonary by-pass (CPB) between December 1991 and December 1993. They comprise 22% of 242 patients operated on without CPB by one of the authors (RM) in this period. There were 45 (85%) males and eight (15%) females. Twelve (23%) patients were over 70 years. Nine (17%) were re-do CABG. Ten (19%) were referred for operation within the first 24 hours of evolving MI, and 13 (25%) up to two weeks after acute MI. Nine (17%) had preoperative EF < 20%, and six patients (11%) were in cardiogenic shock. Mean number of grafts/pt was 1.8 and IMA was used in 41 (77%). Only 14 patients (26%) received a graft to a circumflex marginal artery. Ischemic time was 8 +/- 4 min/graft (mean +/- SD) when anastomosed to the LAD or RCA, and 14 +/- 7 min/graft when anastomosed to a marginal branch.
Results:
One patient (1.9%) died perioperatively, and two (3.7%) suffered a non-fatal MI. At two-year follow-up there were three late deaths, one of them from cancer. Three patients had return of angina, two of them were reoperated upon.
Conclusions:
These results suggest that CABG without CPB may be advantageous for patients with severe LV dysfunction.