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Comparison of myocardial revascularization without cardiopulmonary bypass to standard open heart technique in
L Sternik1, Y Moshkovitz, H Hod
1The Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Insights
Coronary artery bypass surgery without cardiopulmonary bypass showed a trend toward lower operative risk and better survival in patients with left ventricular dysfunction. This off-pump technique may improve outcomes for selected individuals.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Left ventricular (LV) dysfunction poses significant challenges for coronary artery bypass surgery (CABS).
- Standard open-heart techniques using cardiopulmonary bypass (CPB) carry inherent risks, especially in patients with compromised LV function.
Purpose of the Study:
- To compare the efficacy and safety of CABS performed without CPB versus standard on-pump CABS in patients with LV dysfunction (ejection fraction [EF] < 35%).
Main Methods:
- A retrospective study of 117 patients with LV dysfunction undergoing CABS between 1991 and 1994.
- Group A (n=64) underwent off-pump CABS, while Group B (n=53) had on-pump CABS.
- Patient characteristics, surgical details (grafts, arterial use), and postoperative outcomes were analyzed.
Main Results:
- Group A had a higher prevalence of EF < 20% and emergency operations.
- Perioperative mortality was lower in Group A (3.1% vs. 13%), though not statistically significant (P=NS).
- One-year (91% vs. 79%) and two-year (86% vs. 65%) actuarial survival rates were significantly better in Group A (P=0.03 and P=0.04, respectively).
Conclusions:
- Off-pump CABS demonstrated a trend towards reduced operative risk in selected patients with LV dysfunction.
- The findings suggest that CABS without CPB may lead to improved overall survival in this patient population.
- Further research is warranted to confirm these benefits and optimize patient selection for off-pump procedures.
Objective:
To compare myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular (LV) dysfunction.
Methods:
117 patients with LV dysfunction (ejection fraction (EF) < 35%) underwent coronary artery bypass surgery between January 1991 and July 1994. Sixty-four (group A) were operated on without a cardiopulmonary bypass, and 53 (group B) with one. Prevalence of EF < 20% (17 vs. 6%) and emergency operations (22 vs. 7%, P = 0.03) was higher in group A. The average number of grafts was 1.9 +/- 0.8/pt in group A and 3.5 +/- 0.9/pt in group B (P < 0.01), and the internal mammary artery was used in 54 (84%) and 42 (79%) patients, respectively. Only 16 patients (25%) in group A received a graft to a circumflex marginal artery compared to 51 (96%) in group B (P < 0.0001).
Results:
Two patients (3.1%) died perioperatively in group A compared to 7 (13%) in group B (P = NS). In two patients from group A (3.1%) and in four (7.5%) from group B intra-aortic balloon pump was inserted postoperatively (P = NS). One year actuarial survival was 91 and 79% (P = 0.03) and 2-year survival was 86 and 65% (P = 0.04), respectively. Return of angina occurred in five (8%) and three (6%) patients (P = NS).
Conclusions:
These results show a trend for lower operative risk resulting in better overall survival in selected patients with LV dysfunction undergoing coronary artery bypass surgery without cardiopulmonary bypass.