Avoidance of Cardiopulmonary Bypass Improves Early Survival in Multivessel Coronary Artery Bypass Patients with Poor Ventricular Function.
Abstract Background: Patients with diminished ventricular function represent an increasing percentage of candidates for coronary artery bypass grafting (CABG). We have reviewed our recent experience in CABG in patients with ejection fractions (EF) </=30% to identify factors leading to improved outcomes in this high-risk group. Methods: Between January 1997 and September 2002, 990 patients with EF </=30% underwent CABG. Univariate and logistic regression analysis was used to analyze data from 204 patients who underwent revascularization off-pump and 713 patients who underwent grafting with cardiopulmonary bypass (CPB) for differences in mortality, morbidity, and length of stay (LOS). Results: Compared with the on-pump patient cohort, patients with depressed ventricular function who underwent revascularization without the use of CPB had a lower operative mortality rate that trended toward significance (2.9% versus 6.3%; P =.06) and a significantly lower risk-adjusted mortality rate (1.47% versus 4.13%; P <.001), despite a higher predicted risk (5.4% +/- 5.5% versus 4.3% +/- 3.7%; P =.01). Additionally, patients who underwent off-pump bypass grafting had a significantly lower incidence of reoperation for bleeding (1.0% versus 4.6%; P =.02), lower blood product use (39.6% versus 66.6%; P <.001), decreased postoperative ventilation times (11.3 +/- 37.4 hours versus 46.1 +/- 156.1 hours; P <.001), and fewer days in the intensive care unit (2.6 +/- 3.8 days versus 4.2 +/- 6.5 days; P <.001). Logistic regression analysis showed that CPB use ( P =.048; odds ratio [OR], 2.4; 95% confidence interval [CI], 1.0-5.8) and previous CABG ( P =.015; OR, 2.6; 95% CI, 1.2-5.7) were independent risk factors for mortality. A trend toward a shorter LOS (7.6 +/- 7.9 days versus 8.9 +/- 9.6 days; P =.06) was also seen in the off-pump patients. Conclusion: Avoidance of CPB in patients with reduced ventricular function undergoing multivessel bypass improves early survival rates and decreases the incidence of reoperation for bleeding, blood product use, and postoperative ventilatory times.
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
Todd M
TM
Dewey
Morley A.
MA
Herbert
Syma L.
SL
Prince
Mitchell J.
MJ
Magee
James R.
JR
Edgerton
Gregory
G
Trachiotis
E. P.
EP
Alexander
Michael J.
MJ
Mack