Is Off-Pump Coronary Artery Bypass Surgery Superior to On-Pump Coronary Artery Bypass Surgery on Postoperative Paradoxical Ventricular Septal Motion?

Abstract

Background: The aims of this study were to investigate the appearance of paradoxical ventricular septal motion (PSM) after coronary artery bypass graft (CABG) surgery and to identify factors that might be related to this abnormality.

Methods: This prospective study included 119 consecutive patients (38 women, 81 men) who underwent CABG. Patients who underwent on-pump surgery (22 women, 45 men) and patients who underwent off-pump surgery (16 women, 36 men) were studied separately. All subjects underwent preoperative angiographic septal perfusion evaluation, pre- and postoperative echocardiography, and standard electrocardiographic and laboratory investigations, including troponin I and CK-MB levels. Multivariate logistic regression analysis was also performed for a variety of related parameters.

Results: Significant differences in EuroSCORE, length of intensive care unit stay, length of hospital stay, PSM (assessed using echocardiography), septal perfusion (observed using preoperative angiography), postoperative pleural effusion, and intensive care unit recidivism were observed between the two groups (P < .05). Moreover, postoperative PSM was correlated with septal perfusion (r = -0.687^**, P < .001), type of operation (r = -0.194^*, P = .035), diabetes mellitus (r = 0.273^**, P = .003), carotid stenosis (r = 0.235^*, P = .011), the number of distal anastomoses (r = 0.245^**, P = .008), pleural effusion (r = 0.193^*, P = .037), and intensive care unit recidivism (r = 0.249^**, P = .007). However, multivariate analysis demonstrated that only preoperative septal perfusion (odds ratio: 0.037; 95% confidence interval: 0.011-0.128; P < .05) constitutes an independent risk factor for PSM (P < .05).

Conclusions: This study demonstrated that preoperative septal perfusion deficiency represents an independent risk factor for postoperative PSM in patients undergoing CABG. Further investigations addressing the timing of the appearance of PSM and the correlation of this finding with perfusion imaging studies may provide new details concerning the mechanisms that underlie this abnormality.