title: Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center.
abstract: BACKGROUND
  Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction.
  
  
  METHODS
  A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared.
  
  
  RESULTS
  Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less.
  
  
  CONCLUSIONS
  The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.
authors.affiliation: Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China.
authors.forename: LiMin
authors.initials: L
authors.lastname: Xia
authors.affiliation: Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ji
authors.affiliation: Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China.
authors.forename: Kai
authors.initials: K
authors.lastname: Song
authors.affiliation: Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China.
authors.forename: JinQiang
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China.
authors.forename: YunQing
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China.
authors.forename: RunHua
authors.initials: R
authors.lastname: Ma
authors.affiliation: Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China.
authors.forename: WenJun
authors.initials: W
authors.lastname: Ding
authors.affiliation: Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China. wang.chunsheng@zs-hospital.sh.cn.
authors.forename: ChunSheng
authors.initials: C
authors.lastname: Wang
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left
keywords: Coronary artery bypass grafting; Off-pump; On-pump beating heart surgery; Severe left ventricular dysfunction