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Ann Thorac Surg 2002;74:S1344-S1347
© 2002 The Society of Thoracic Surgeons

Supplement: Cardiothoracic Techniques and Technologies

Surgical revascularization in patients with poor left ventricular function: on- or off-pump?

Hani Shennib, MDa*, Munemoto Endo, MDa, Osama Benhamed, MDa, Jean F. Morin, MDa

a Division of Cardiothoracic Surgery, The Montreal General Hospital, Montreal, Quebec, Canada

* Address reprint requests to Dr Shennib, Division of Cardiothoracic Surgery, The Montreal General Hospital, 1650 Cedar Avenue, Room L9-121, Montreal, QC, H3G 1A4, Canada
e-mail: hani.shennib{at}muhc.mcgill.edu

Presented at the Eighth Annual Cardiothoracic Techniques and Technologies Meeting 2002, Miami Beach, FL, Jan 23–26, 2002.

BACKGROUND: Patients with left ventricular dysfunction and low ejection fraction (EF) are at high-risk of complication and mortality after coronary artery bypass grafting (CABG). The potential success of off-pump CABG in this high-risk population has yet to be determined. The purpose of this study is to compare the outcome of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass (CCAB) in patients with poor left ventricular function, all from a single institution.

METHODS: Data on patient demographics, preoperative risk factors, operative and postoperative outcomes were collected retrospectively on all patients having undergone isolated CABG between January 1, 1998, and October 31, 2001.

RESULTS: A total of 77 patients (31 OPCAB/46 CCAB) were identified as having an ejection fraction (EF) of <=0.35. Of these, 52 had EF <= 0.30 (21 OPCAB/31 CCAB) and 31 patients had EF <= 0.25 (10 OPCAB/21 CCAB). Operative mortality was 3.2% after the OPCAB procedure versus 10.9% for the CCAB (p = 0.39). Use of intraaortic balloon pump (6.5%) was rarely required. The OPCAB procedure resulted in significantly less requirement for blood transfusions (p < 0.05), fewer distal anastomoses per patient (p < 0.01), and a higher incidence of atrial fibrillation (p < 0.05) compared with CCAB.

CONCLUSIONS: Patients with poor left ventricular function may undergo surgical revascularization using off-pump technique with relatively good results and low mortality levels. The lower number of grafts performed on the off-pump procedure did not seem to affect clinical outcomes.




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