On-Pump/Beating-Heart Myocardial Protection for Isolated or Combined Coronary Artery Bypass Grafting in Patients with Severe Left Ventricle Dysfunction: Assessment of Myocardial Function and Clinical Outcome

Authors

  • Oner Gulcan
  • Riza Turkoz
  • Ayda Turkoz
  • Esra Caliskan
  • Alpay T. Sezgin

DOI:

https://doi.org/10.1532/HSF98.20041166

Abstract

Background: Myocardial protection in coronary artery bypass grafting (CABG) with severe left ventricular (LV) dysfunction is still a surgical dilemma. Preoperative myocardial infarction (MI) and postoperative low output syndrome are serious complications in cases of inadequate protection of the heart, which has limited myocardial reserve. The aim of this study was to evaluate myocardial function and clinical outcome after on-pump/beating-heart CABG in patients with severe LV dysfunction.

Methods: Between March 2001 and March 2004, clinical, operative, and postoperative data were prospectively collected from patients with LV ejection fraction (EF) <30% who underwent on-pump/beating-heart CABG and associated procedures.

Results: There were 46 patients and the mean patient age was 58.38 ± 9.23. The mean EF was 25.6 ± 2.8%. Operating time was 275 ± 63 minutes. The frequency of distal anastomosis was 3.06 ± 1.04. Twenty-four patients required aneurysmectomy in addition to CABG, and 2 of the 24 required mitral repairs. Inotropic support was required in 14 patients (30%) and 5 of them (10.9%) also required IABP. The LV EF improved significantly after the operation when compared to preoperative measurements (25.6 ± 2.8 versus 33.64 ± 4.69, P < .05). Hospital mortality rate was 4.3% (2 of the 46 patients). No mortality was observed at a mean followup of 16 months after discharge from the hospital.

Conclusions: On-pump/beating-heart CABG technique is effective in protecting myocardial functions in patients with severe LV dysfunction. The main advantage of the on-pump/beating-heart technique is the ability it provides one to perform complete revascularization, and intracavitary procedures with low morbidity and mortality even in impaired LV function.

References

Akins CW. 1992. Hypothermic fibrillatory arrest for coronary artery bypass grafting. J Card Surg 7:342-47.nAlfieri O, Maisano F. 1999. An effective technique to correct anterior mitral leaflet prolapse. J Card Surg 14:468-70.nAntunes PE, Oliveira JF, Antunes MJ. 1999. Non-cardioplegic coronary surgery in patients with severe left ventricular dysfunction. Eur J Cardiothorac Surg 16:331-6.nAntunes PE, de Oliveira JM, Antunes MJ. 2003. Coronary surgery with non-cardioplegic methods in patients with advanced left ventricular dysfunction: immediate and long term results. Heart 89:427-31.nAscione R, Lloyd CT, Gomes WJ, Caputo M, Bryan AJ, Angelini GD. 1999. Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study. Eur J Cardiothorac Surg 15: 685-90.nAscione R, Narayan P, Rogers CA, Lim KH, Capoun R, Angelini GD. 2003. Early and midterm clinical outcome in patients with severe left ventricular dysfunction undergoing coronary artery surgery. Ann Thorac Surg 76:793-99.nBonchek LI, Burlingame MW, Vazales BE, Lundy EF, Gassmann CJ. 1992. Applicability of non-cardioplegic coronary bypass to high-risk patients. Selection of patients, technique, and clinical experience in 3000 patients. J Thorac Cardiovasc Surg 103:230-37.nBuckberg GD, Hottenrott CE. 1975. Ventricular fibrillation. Its effect on myocardial flow, distribution, and performance. Ann Thorac Surg 20:76-85.nChristakis GT, Weisel RD, Fremes SE, et al. 1992. Coronary arterybypass grafting in patients with poor ventricular function. Cardiovascular Surgeons of the University of Toronto. J Thorac Cardiovasc Surg 103:1083-92.nEdgerton JR, Dewey TM, Magee MJ, et al. 2003. Conversion in off-pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg 76:1138-43.nEdgerton JR, Herbert MA, Jones KK, et al. 2004. On-Pump Beating Heart Surgery Offers an Alternative for Unstable Patients Undergoing Coronary Artery Bypass Grafting. Heart Surg Forum 7(1):8-15.nElefteriades JA, Kron IL. 1995. CABG in advanced left ventricular dysfunction. Cardiol Clin 13:35-42.nEnriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL. 1995. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation 91:1022-28.nGoldstein DJ, Beauford RB, Luk B, et al. 2003. Multivessel off-pump revascularization in patients with severe left ventricular dysfunction. Eur J Cardiothorac Surg 24:72-80.nKaul TK, Agnihotri AK, Fields BL, Riggins LS, Wyatt DA, Jones CR. 1996. Coronary artery bypass grafting in patients with an ejection fraction of twenty percent or less. J Thorac Cardiovasc Surg 111:1001-12.nKhan NE, De Souza A, Mister R, et al. 2004. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med 1;350(1):21-8.nMeharwal ZS, Mishra YK, Kohli V, Bapna R, Singh S, Trehan N. 2002. Off-pump multivessel coronary artery surgery in high-risk patients. Ann Thorac Surg 74:S1353-7.nMeharwal ZS, Trehan N. 2002. Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction. Heart Surg Forum 5:41-5.nMickleborough LL, Maruyama H, Takagi Y, Mohamed S, Sun Z, Ebisuzaki L. 1995. Results of revascularization in patients with severe left ventricular dysfunction. Circulation 92(Suppl 2):73-9.nMoshkovitz Y, Sternik L, Paz Y, et al. 1997. Primary coronary artery bypass grafting without cardiopulmonary bypass in impaired left ventricular function. Ann Thorac Surg 63(6 Suppl):S44-7.nOmeroglu SN, Kirali K, Guler M, et al. 2000. Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 70:844-50.nPerrault LP, Menasché P, Peynet J, et al. 1997. On-pump, beating-heart coronary artery operations in high-risk patients: an acceptable trade-off? Ann Thorac Surg 64:1368-73.nPigott JD, Kouchoukos NT, Oberman A, Cutter GR. 1985. Late results of surgical and medical therapy for patients with coronary artery disease and depressed left ventricular function. J Am Coll Cardiol 5:1036-45.nPrifti E, Bonacchi M, Giunti G, Frati G, Leacche M, Bartolozzi F. 2003. Beating heart ischemic mitral valve repair and coronary revascularization in patients with impaired left ventricular function. J Card Surg 18:375-83.nRao V, Ivanov J, Weisel RD, Cohen G, Borger MA, Mickle DA. 2001. Lactate release during reperfusion predicts low cardiac output syndrome after coronary bypass surgery. Ann Thorac Surg 71(6):1925-30.nScott SM, Deupree RH, Sharma GV, Luchi RJ. 1994. VA study of unstable angina. 10-year results show duration of surgical advantage for patients with impaired ejection fraction. Circulation 90(suppl2):120-23.nSternik L, Moshkovitz Y, Hod H, Mohr R. 1997. Comparison of myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular dysfunction. Eur J Cardiothorac Surg 11:123-8.n

Published

2005-06-03

How to Cite

Gulcan, O., Turkoz, R., Turkoz, A., Caliskan, E., & Sezgin, A. T. (2005). On-Pump/Beating-Heart Myocardial Protection for Isolated or Combined Coronary Artery Bypass Grafting in Patients with Severe Left Ventricle Dysfunction: Assessment of Myocardial Function and Clinical Outcome. The Heart Surgery Forum, 8(3), E178-E183. https://doi.org/10.1532/HSF98.20041166

Issue

Section

Article