[Beating heart surgery and left ventricular dysfunction].
We report our experience with systematic coronary revascularization on the beating heart among patients with left ventricular dysfunction as defined by a left ventricular ejection fraction < or = 40%. Between September 1996 and April 2000, 500 off-pump (OPCAB) revascularizations were performed (95% of all revascularizations for the same time frame, single surgeon). Among them, 76 patients qualified as left ventricular dysfunction and were compared to a similar cohort of 237 patients operated on with cardiopulmonary bypass (CPB) during the same time frame. Age and sex distribution, average preoperative left ventricular ejection fraction and incidence of preoperative unstable angina were the same for both groups. On average, 3.04 +/- 0.89 and 2.97 +/- 0.69 grafts/patient were made in the OPCAB and CPB groups respectively (p = NS). Complete revascularization was achieved in 95% of the OPCAB group. Incidence of preoperative intra-aortic balloon assistance were higher in OPCAB (22% versus 9%, p = 0.005) whereas postoperative need for new intra-aortic balloon assistance was higher in CPB (8% versus 0%, p = 0.02). Incidence of postoperative myocardial infarction was comparable in both groups (6.5% versus 5.5%). Maximal creatinine phosphate of myocardial origin were lower in OPCAB group (beating heart: 32 +/- 52%, cardiopulmonary bypass: 45 +/- 51%, p = 0.055). Operative mortality was lower in OPCAB group although it did not reach statistical significance (beating heart: 2.6% versus cardiopulmonary bypass: 4.6%, p = 0.3). Complete coronary revascularization on the beating heart can be achieved in patients with left ventricular dysfunction with excellent outcome and low operative mortality.
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Département de chirurgie cardiaque, institut de cardiologie de Montréal, 5000 est, rue Bélanger, Montréal, Québec H1T 1C8, Canada. rc2910@aol.com
Martineau
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Couturier
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D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications*