Off-pump coronary bypass surgery is safe in patients with a low ejection fraction (< or =25%).
BACKGROUND
A severely decreased ejection fraction (EF) of < or =25% is an established risk factor for a worse outcome after heart surgery and therefore has been incorporated into the EuroSCORE risk-stratification model. We compare clinical outcomes after off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting in patients with a severely compromised EF.


METHODS
We compared 112 patients with a low EF (< or =25%) who underwent myocardial revascularization between 2003 and 2008. Forty-four patients underwent OPCAB (group A), and 68 patients underwent on-pump surgery (group B). We compared demographics, intraoperative parameters, intraoperative outcomes, and the completeness of revascularization for the 2 groups.


RESULTS
Demographic and EuroSCORE data were comparable for groups A and B. The 2 groups appeared to be similar with respect to mortality rate during the first 30 days (2.2% and 8.8%, respectively; P = .11) and the rate of major complications such as stroke (2.2% and 2.9%, respectively; P = 0.83). The patients in group A had fewer pulmonary complications (7% versus 25%, P < .01), received fewer blood transfusions (15.9% versus 47.0%, P < .01), required fewer postoperative pacing procedures (atrial, 11.4% versus 39.7%; ventricular, 13.6% versus 47.1%; P < .01), and had fewer wound infections (2.2% versus 16.1%, P = .02). The numbers of diseased vessels were comparable, and although the OPCAB patients received more arterial grafts (1.05 +/- 0.43 versus 0.84 +/- 0.37, P < .01), the total number of grafts per patient was lower among these patients (2.50 +/- 0.88 versus 3.53 +/- 0.92, P = .03). Similarly, complete revascularization was achieved less frequently within this group (80% versus 94%, P = .02).


CONCLUSIONS
A standardized OPCAB approach in patients with a severely decreased EF is safe and may benefit this subset of patients with respect to fewer postoperative complications. Although complete revascularization is the optimal approach for these patients, they benefit from avoiding cardiopulmonary bypass.
Emmert
Maximilian Y
MY
Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, Singapore.
Emmert
Lorenz S
LS
Martinez
Eliana C
EC
Lee
Chuen N
CN
Kofidis
Theo
T
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006305:Health Status Indicators; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left