title: Off-pump surgery is not a contraindication for patients with a severely decreased ejection fraction.
abstract: BACKGROUND
  A severely impaired left ventricular ejection fraction (EF) (30%) increases the risk of surgical myocardial revascularization. We evaluated the safety and feasibility of off-pump coronary artery bypass (OPCAB) surgery in patients with a severely decreased EF.
  
  
  METHODS
  We compared 79 patients with an EF ≤30% (group A) with 863 patients with an EF >30% (group B) who underwent myocardial revascularization between 2003 and 2008. The relationship between EF and outcome after OPCAB was assessed by univariate and logistic regression analyses. A composite end point was constructed from 30-day mortality, renal failure, length of stay in the intensive care unit (ICU) >2 days, neurologic complications, and use of an intra-aortic balloon pump (IABP). Additionally, the completeness of revascularization was assessed.
  
  
  RESULTS
  The mortality rates for groups A and B were comparable (1.3% and 2.0%, respectively; P = .55), and the 2 groups did not differ with regard to serious postoperative complications, such as stroke (2.5% versus 1.4% for groups A and B, respectively; P = .42), peripheral neurologic complications (2.5% versus 0.7%, P = .14), renal failure (0% versus 1.1%, P = 1.00), use of an IABP (1.3% versus 0.8%, P = .50), ICU length of stay >2 days (17.7% versus 19.6%, P = .77). Similarly, groups A and B did not differ with regard to ventilation time (11.2 ± 12.7 hours versus 12.4 ± 15.5 hours, P = .82), indicating similar postoperative courses for the 2 groups of patients. In contrast, the composite end point occurred significantly more frequently in group A (43.0% versus 29.7%, P = .02), a result driven by the increased rate of rethoracotomy for bleeding in that group (11.4% versus 2.9%, P = .001). The 2 groups were similar with respect to the total number of grafts used per patient (3.82 ± 0.89 versus 3.63 ± 1.01, P = .10) and the completeness of revascularization (94% versus 93%, P = .49).
  
  
  CONCLUSIONS
  A standardized OPCAB approach is safe for patients with a severely decreased EF, and its use does not come at the cost of less complete revascularization.
authors: Department of Cardiac Surgery, Stadtspital Triemli, Zurich. maximilian.emmert@usz.ch
authors: Maximilian Y
authors: MY
authors: Emmert
authors: Sacha P
authors: SP
authors: Salzberg
authors: Burkhardt
authors: B
authors: Seifert
authors: Ulrich P
authors: UP
authors: Schurr
authors: Oliver M
authors: OM
authors: Theusinger
authors: Simon P
authors: SP
authors: Hoerstrup
authors: Oliver
authors: O
authors: Reuthebuch
authors: Michele
authors: M
authors: Genoni
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D013318:Stroke Volume; D013557:Switzerland; D016896:Treatment Outcome; D016277:Ventricular Function, Left