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 grou p 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 equals).


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 the presence of unfavorable risk factors. Off-pump surgery with selective anterior (including right main) arterial revascularization can be indicated in the presence of poor LV function.
Jasinski
Marek J
MJ
2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland. Marekjas@hotmail.com
Wos
Stanislaw
S
Olszowka
Piotr
P
Szafranek
Adam
A
Bachowski
Ryszard
R
Ceglarek
Wojciech
W
Widenka
Kazimierz
K
Gemel
Marek
M
Deja
Marek
M
Szurlej
Dariusz
D
D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000601:surgery*