702 - Coronary artery bypass surgery in patients with left ventricular ejection fraction <30%. A single center study

Introduction Coronary Artery Bypass Grafting (CABG) in patients with severely reduced left ventricular ejection fraction (LVEF) is associated with increased incidence of adverse peri-operative outcomes. In this high-risk cohort, the use of the optimal surgical technique, on pump (ONCAB) or off pump (OPCABG), remains controversial. We aimed to compare the in-hospital clinical outcomes and mid-term survival. Methods A single-centre, retrospective study of prospectively collected data in patients with LVEF ≤30% who underwent first-time isolated CABG from January 2016 to December 2023. The primary outcome was early in-hospital mortality and mid-term survival. Results We analyzed a total of 147 consecutive (elective or urgent) patients ONCAB N = 90 and OPCABG N = 57. Patients' characteristics were similar in the two groups. The median number of grafts received in ONCAB was significantly higher than OPCAB, 3 (IQR 3,3) versus 2 (IQR 2,3), respectively, P < 0.001. There was no significant difference in-hospital mortality between the two groups (OPCABG versus ONCAB; 0/57 (0%) and 5/90 (5.6%) P = 0.2). The incidence of peri-operative complications was lower in OPCAB group compared to ONCAB, however it did not reach statistically significance. Mid-term survival at 40 months was comparable among the groups, OPCABG 82.6% versus 84.8% (log rank P = 0.68). Conclusions OPCABG and ONCAB are both safe techniques with similar in-hospital and mid-term mortality among patients with severely reduced left ventricular ejection function. OPCABG seemed to reduce the incidence of peri-operative complications; however, it is associated with less complete revascularization.