Dysfunction of Left Ventricle as an Indication for Off-Pump Coronary Artery Bypass Grafting
Background: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass carries significant risk for patients with severe left ventricular (LV) dysfunction.
Methods: Between 1997 and 2000, 240 patients underwent OPCAB. The patients were retrospectively divided into 2 groups with regard to LV function. Group 1 consisted of 90 patients with ejection fraction (EF) < 35% and group 2 of 150 patients without severe LV impairment and EF > 35%. Patients were compared for preoperative risk factors, perioperative mortality, and postoperative complications.
Results: Preoperative expected mortality according to EuroSCORE was higher in group 1, 5.95, compared with group 2, 2.66 (P = .0005). A few preoperative risk factors were more common in group 1: urgent operation (P = .00001), unstable angina (P = .0018), Canadian Cardiovascular Society class (P = .001), myocardial infarction (P = .0001), and peripheral arteriopathy (P = .0006). Mean number of grafts was 1.51 in group 1 and 1.55 in group 2 with the same internal thoracic artery utilization. Perioperative drainage, anesthesia and intubation time, transfusion rate, and use of inotropes were comparable. Actual, nonadjusted mortality was 2.5% in group 1 and 1.4% in group 2 (P = not significant). Overall rates of postoperative complications were comparable; only use of an intraoperative balloon pump was more frequent in group 1 (P = .006). Postoperative stay was shorter in group 1 (P = .007).
Conclusions: Off-pump CABG for patients with LV impairment is associated with surgical outcome similar to that among patients with normal LV function, in spite of
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