The Influence of Left Ventricular Dysfunction on The Early and Midterm Outcome in The Patients Undergoing Off Pump Coronary Artery Bypass Grafting Assessed by Propensity Matched Score Analysis

Off pump CABG for Low EF patient

Authors

  • Tomonori Shirasaka Division of Cardiothoracic Surgery, Lampang Hospital, Lampang, Thailand
  • Nuttapon Arayawudhikul Division of Cardiac Surgery, Asahikawa Medical University Hospital, Hokkaido, Japan
  • Apichat Tantraworasin Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • Angsu Chartrungsan Clinical Epidemiology and Clinical Statistic Unit, Faculty of Medicine, and Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
  • Boonsap Sakboon Division of Cardiac Surgery, Asahikawa Medical University Hospital, Hokkaido, Japan
  • Jaroen Cheewinmethasiri Division of Cardiac Surgery, Asahikawa Medical University Hospital, Hokkaido, Japan
  • Hiroyuki Kamiya Division of Cardiothoracic Surgery, Lampang Hospital, Lampang, Thailand

DOI:

https://doi.org/10.1532/hsf.4311

Abstract

Background: It still remains unclear the depth of influence of left ventricular dysfunction on the recovery of patients’ physical conditions in the early and midterm period following off-pump coronary artery bypass grafting (OPCAB).

Methods: From April 2011 to May 2018, 851 patients underwent OPCAB in our center. All were grouped into two groups: Those whose ejection fraction (EF) was under 35% were defined as the Low EF group (N = 158) and those who maintained EF over 35% were defined as the Faired EF group (N = 693). Preoperatively, there was significant difference in NYHA class (P < 0.001), CCS class (P = 0.038), level of creatinine (P < 0.001), and rate of establishment of IABP (P < 0.001).

Results: Regarding all-cause death in the early postoperative period, low EF was a not a risk factor in patients (P = 0.52) or in the matched cohort (P = 0.398); however, in the midterm, it was a significant risk factor in patients (HR 2.07, P = 0.016) and in the matched cohort (HR 2.72, P = 0.029). Overall survival at 5 years in the Low EF group was significantly inferior to that of the Faired EF group in all (67.4±4.1% and 86.1±2.9%, P = 0.001) and in the matched cohort (66.5±6.4% vs. 86.5±4.5%, P = 0.008).

Conclusion: OPCAB seems beneficial for patients with LV dysfunction considering the early outcome, however, low EF is a significant risk factor for overall death in the midterm period.

References

Appoo J, Norris C, Merali S, et al. 2004. Long-term outcome of isolated coronary artery bypass surgery in patients with severe left ventricular dysfunction. Circulation. 110: II13-7.

Bouchart F, Tabley A, Litzler PY, et al. 2001. Myocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long term follow-up in 141 patients. Eur J Cardiothorac Surg. 20: 1157-62.

Carr JA, Haithcock BE, Paone G, et al. 2002. Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction. Ann Thorac Surg. 74: 1531-6.

Christakis GT, Ivanov J, Weisel RD, Birnbaum PL, David TE, Salerno TA. 1989. The Cardiovascular Surgeons of the University of Toronto: The changing pattern of coronary artery bypass surgery. Circulation. 80 Suppl: I151-I161.

Cooper WA, Brien SM, Thourani VH, et al. 2006. Impact of renal dysfunction on outcomes of coronary artery bypass surgery. Results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation. 113:1063–1070.

Craver JM, Murrah CP. 2001. Elective intraaortic balloon counterpulsation for high-risk off-pump coronary artery bypass operations. Ann Thorac Surg. 71: 1220-1223.

Fukui T, Tabata M, Takanashi S. 2014. Long-term outcomes after off-pump coronary artery bypass grafting in left ventricular dysfunction. Ann Thorac Cardiovasc Surg. 20: 143–149.

Jarral OA, Srdjan Saso, Athanasiou T. 2011. Off-pump coronary artery bypass in patients with left ventricular dysfunction: A meta-analysis. Ann Thorac Surg. 92:1686–94.

Keeling WB, Williams ML, Slaughter MS, Zhao Y, Puskas JD. 2013. Off-pump and on-pump coronary revascularization in patients with low ejection fraction: a report from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 96:83-8.

Kim KB, Lim C, Ahn H, Yang JK. 2001. Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg. 71: 1964-1968.

Komiya T. 2009. Coronary artery bypass surgery for patients with renal failure. J Jpn Coron Assoc. 15: 246–251.

Kuroda K, Kato ST, Kuwaki K, et al. 2016. Early postoperative outcome of off-pump coronary artery bypass grafting: A Report from the highest-volume center in Japan. Ann Thorac Cardiovasc Surg. 22: 98–107.

Kuss O, von Salviati B, Börgermann J. 2010. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses. J Thorac Cardiovasc Surg. 140: 829-35.

Marui A, Okabayashi H, Komiya T, et al. 2012. Benefits of off-pump coronary artery bypass grafting in high-risk patients. Circulation. 126: 151-7.

Matsuo S, Imai E, Horio M, et al. 2009. Revised equation for estimated GFR serum creatinine in Japan. Am J Kidney Dis. 53:982–92.

McCullough PA. 2002. Cardiorenal risk: an important clinical intersection. Rev Cardiovasc Med. 3:71–76.

Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C. 2008. Clinical outcomes in randomized trials of off- vs. on-pump coronary artery bypass surgery: systematic review with meta-analyses and trial sequential analyses. Eur Heart J. 29:2601–16.

Pieri M, Belletti A, Monaco F, et al. 2016. Outcome of cardiac surgery in patients with low preoperative ejection fraction. BMC Anesthesiology. 16:97.

Puskas JD, Williams WH, Duke PG, et al. 2003. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cradiovasc Surg. 125: 797-808.

Shroyer AL, Grover FL, Hattler B, et al. 2009. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 361:1827–37.

Taggart DP. 2016. Off-pump coronary artery bypass grafting (OPCABG)—a ‘personal’ European perspective. J Thorac Dis. 8 (Suppl 10):S829-S831.

Topkara VK, Cheema FH, Kesavaramanujam S, et al. 2005. Coronary artery bypass grafting in patients with low ejection fraction. Circulation. 112: I344-50.

Ueki C, Miyata H, Motomura N, Sakaguchi G, Akimoto T, and Takamoto S. 2016. Off-pump versus on pump coronary artery bypass grafting in patients with left ventricular dysfunction. J Thorac Cardiovasc Surg. 151:1092-8.

Vohra HA, Wadih R, Dimitri WR. 2006. Elective Intraaortic balloon counterpulsation in high-risk off-pump coronary artery bypass grafting. J Card Surg. 21:1-5.

Published

2022-02-07

How to Cite

SHIRASAKA, T., Arayawudhikul, . N. ., Tantraworasin, A. ., Chartrungsan, A. ., Sakboon, B., Cheewinmethasiri, J. ., & Kamiya, H. (2022). The Influence of Left Ventricular Dysfunction on The Early and Midterm Outcome in The Patients Undergoing Off Pump Coronary Artery Bypass Grafting Assessed by Propensity Matched Score Analysis: Off pump CABG for Low EF patient. The Heart Surgery Forum, 25(1), E101-E107. https://doi.org/10.1532/hsf.4311

Issue

Section

Article