Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction.
BACKGROUND
Coronary artery bypass grafting in patients with severe left ventricular (LV) dysfunction still remains a high risk procedure due to its high mortality and morbidity. Off-pump surgery can be an alternative technique in these patients. We analyzed our results of off-pump coronary surgery in patients with left ventricular dysfunction and compared them with patients operated on-pump.


METHODS
Between January 1997 and December 2000, 355 patients with LV dysfunction (EF equal to or less than 30%) underwent off-pump coronary artery bypass (OPCAB) surgery. During the same period, 959 patients with LV dysfunction underwent coronary artery surgery on cardiopulmonary bypass. Octopus was used as mechanical stabilizer and intracoronary shunts were used in most patients. The mean age of the patients was 57.7 +/- 9.2 in patients operated on-pump and 58.4 +/- 9.8 in patients operated off-pump.


RESULTS
The preoperative variables were comparable in two groups, except that there were more patients with triple vessel disease in on-pump group. Average number of grafts was 2.8 +/- 0.7 and 3.3 +/- 0.7 (p<0.001) in off-pump and on-pump groups respectively. The mortality was 3.9% and 6.0% (p = 0.176) in off-pump and on-pump groups respectively. Postoperative morbidity was less in off-pump group but it was statistically significant in incidence of atrial fibrillation and prolonged ventilation which were low in off-pump group. The hospital stay was significantly less in patients operated off-pump.


CONCLUSIONS
OPCAB surgery can be safely performed in patients with LV dysfunction. The postoperative morbidity and length of stay is less as compared to patients operated on-pump.
Meharwal
Zile Singh
ZS
Department of Cardiovascular Surgery, Escorts Heart Institute And Research Centre, New Delhi, India. meharwal@hotmail.com
Trehan
Naresh
N
D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D018487:Ventricular Dysfunction, Left / Q000150:complications*