title: Comparison of myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular dysfunction.
abstract: OBJECTIVE
  To compare myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular (LV) dysfunction.
  
  
  METHODS
  117 patients with LV dysfunction (ejection fraction (EF) < 35%) underwent coronary artery bypass surgery between January 1991 and July 1994. Sixty-four (group A) were operated on without a cardiopulmonary bypass, and 53 (group B) with one. Prevalence of EF < 20% (17 vs. 6%) and emergency operations (22 vs. 7%, P = 0.03) was higher in group A. The average number of grafts was 1.9 +/- 0.8/pt in group A and 3.5 +/- 0.9/pt in group B (P < 0.01), and the internal mammary artery was used in 54 (84%) and 42 (79%) patients, respectively. Only 16 patients (25%) in group A received a graft to a circumflex marginal artery compared to 51 (96%) in group B (P < 0.0001).
  
  
  RESULTS
  Two patients (3.1%) died perioperatively in group A compared to 7 (13%) in group B (P = NS). In two patients from group A (3.1%) and in four (7.5%) from group B intra-aortic balloon pump was inserted postoperatively (P = NS). One year actuarial survival was 91 and 79% (P = 0.03) and 2-year survival was 86 and 65% (P = 0.04), respectively. Return of angina occurred in five (8%) and three (6%) patients (P = NS).
  
  
  CONCLUSIONS
  These results show a trend for lower operative risk resulting in better overall survival in selected patients with LV dysfunction undergoing coronary artery bypass surgery without cardiopulmonary bypass.
authors.affiliation: The Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Sternik
authors.forename: Y
authors.initials: Y
authors.lastname: Moshkovitz
authors.forename: H
authors.initials: H
authors.lastname: Hod
authors.forename: R
authors.initials: R
authors.lastname: Mohr
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology