title: The influence of a low ejection fraction on long-term survival in systematic off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  Poor left-ventricular ejection fraction (EF) is a recognized operative and long-term risk factor in coronary artery bypass surgery. Over the past decade, off-pump coronary artery bypass surgery has emerged as a new strategy to address myocardial revascularization in poor left-ventricular EF patients, but few reports have documented long-term results. The aim of this study was to investigate long-term clinical results in off-pump coronary artery bypass patients with ≤ 35% left-ventricular EF.
  
  
  METHODS
  From September 1996 to May 2006, 1250 patients underwent off-pump coronary artery bypass revascularization, and were prospectively followed-up at the Montreal Heart Institute. Among them, 137 patients (pts) had a preoperative left-ventricular EF ≤ 35%. Follow-up was completed in 97% of patients.
  
  
  RESULTS
  Mean follow-up was 66 ± 34 months. Rate of grafts per pts was comparable in both groups. Overall 30-day mortality was 1.7% (1.5% EF >35% pts vs 2.9% in EF ≤ 35% pts; p = 0.19). Ten-year survival was lower in poor EF patients (44 ± 7% vs 76 ± 2%), and remained significant even after adjusting for risk factors (p = 0.04). Freedom from cardiac death for both groups was also significantly reduced in poor EF patients (p = 0.008). After adjustment, freedom from the combined end point of cardiac or sudden death, myocardial infarction, repeat coronary revascularization, unstable angina, and cardiac failure was comparable in both groups (p = 0.5).
  
  
  CONCLUSIONS
  Off-pump coronary artery bypass surgery can be performed adequately and safely in poor EF patients. However, overall and cardiac survival was decreased in this subset of patients with a comparable freedom from major cardiac adverse related events.
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute/Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.forename: Martin
authors.initials: M
authors.lastname: Ladouceur
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality; D003643:Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000401:mortality / Q000503:physiopathology