title: Multivessel off-pump revascularization in patients with severe left ventricular dysfunction.
abstract: OBJECTIVE
  The purpose of this study was to investigate the safety and efficacy of multivessel beating heart revascularization in a high-risk group of patients with severe left ventricular dysfunction as well as to provide intermediate survival and quality of life data.
  
  
  METHODS
  Our prospectively updated database was queried to extract all patients with left ventricular ejection fraction < or =30% who underwent beating heart revascularization. Standard demographics, clinical profiles and outcomes were collected. Outcomes were compared with Society of Thoracic Surgeons (STS) benchmarks for all coronary artery bypass grafting (CABG) patients. Telephone interviews were conducted and survival and quality of life data were tabulated. In addition, morbidity and mortality outcomes were compared with a concurrent cohort of patients with similarly impaired left ventricular function who underwent conventional coronary artery bypass.
  
  
  RESULTS
  One hundred off-pump coronary artery bypass grafting patients were identified and follow-up was 93% complete in these patients. Mean age was 67+/-10.5 years and mean ejection fraction was 26+/-4%. Twenty-one percent were females. Balloon counterpulsation support was used liberally in the perioperative period. Patients received a mean of 3.5 grafts with 83% internal mammary artery use. Observed mortality was 3% with a predicted mortality of 5.3%. Observed to expected ratio was 0.56. Incidence of adverse events compared favorably with both that reported in the STS for all CABG patients regardless of left ventricular function, and also to a concurrent CABG cohort. One-year survival was 85%. Freedom from cardiac readmission was 88% and freedom from angina was 83%. No patient required repeat percutaneous or surgical intervention.
  
  
  CONCLUSIONS
  We conclude that multivessel off-pump revascularization in patients with severe left ventricular dysfunction is a safe and effective alternative to conventional grafting. Long-term follow-up is mandatory to confirm these encouraging intermediate outcomes.
authors.affiliation: Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center and Saint Barnabas Hospital, 201 Lyons Avenue, Newark, NJ 07112, USA. dgoldstein@sbhcs.com
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Goldstein
authors.forename: Robert B
authors.initials: RB
authors.lastname: Beauford
authors.forename: Brandon
authors.initials: B
authors.lastname: Luk
authors.forename: Ravindra
authors.initials: R
authors.lastname: Karanam
authors.forename: Thomas
authors.initials: T
authors.lastname: Prendergast
authors.forename: Frederic
authors.initials: F
authors.lastname: Sardari
authors.forename: Paul
authors.initials: P
authors.lastname: Burns
authors.forename: Craig
authors.initials: C
authors.lastname: Saunders
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality / Q000601:surgery*