Why the study?
To evaluate the early outcomes of OPCAB in terms of mortality and major post-operative morbidities compared with CCAB in patients with multivessel coronary artery disease and reduced LV function.
Does off-pump coronary artery bypass (OPCAB) improve early postoperative outcomes compared to conventional CABG in patients with multivessel coronary artery disease and reduced left ventricular ejection fraction?
Does off-pump coronary artery bypass (OPCAB) improve early postoperative outcomes compared to conventional CABG in patients with multivessel coronary artery disease and reduced left ventricular ejection fraction?
In patients with multivessel coronary artery disease and reduced LVEF, off-pump CABG is associated with reduced operative time, blood loss, and hospital stay compared to conventional CABG, without increasing early mortality.
OPCAB may shorten recovery in low-EF patients; leaves open superiority over CCAB in randomized trials.
Introduction: Left ventricular dysfunction is an important predictor of in-hospital mortality. Due to the theoretical and practical advantages to avoid the harmful effects of cardiopulmonary bypass (CPB), many cardiac surgeons are using Off-pump Coronary Artery Bypass (OPCAB)as an effective alternative to conventional CABG (CCAB) even in patients with reduced left ventricular (LV)ejection fraction. Objectives: This study performed in the National Institute of Cardiovascular Diseases (NICVD) evaluated the early outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of CCAB in patients with multivessel coronary artery diseases and reduced left ventricular (LV) function. Methods: Total 120 patients with multivessel coronary artery disease with reduced left ventricular ejection fraction (d”50%)were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2013 and December 2015. Pre-operative, peroperative and early post-operative variables were recorded, compiled and compared. Results: All risk factors and co-morbidities were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarter (73.3%) of patients in OPCAB group and 80% in CCAB group received 3 grafts (p=0.470). The mean total operative time (268.5 ± 33.5vs. 296.3 ± 34.8minutes, p < 0.001), intubation times(8.6±0.3 vs. 12.3±0.5 hours, p<0.001), blood losses (377.8378 ± 45 ml vs. 602 ± 60 ml, p < 0.001); requirements for blood and blood products (689.7±21.1 vs. 1199.3±34.5ml, p < 0.0010),intensive care unit stays (31.7±0.9 hours versus 41.6±1.5 hours; p<0.001) and hospital stays (8.2 ± 0.2days vs.10.3 ± 0.3days, p < 0.001)were all significantly lower in the OPCAB group. Conclusion: OPCAB is a safe and effective operative revascularization procedure for patients with multivessel coronary artery disease and left ventricular dysfunction and is associated with reduced morbidity. However, a larger and omized trial with long-term followup may show the real benefits of OPCAB. Bangladesh Heart Journal 2020; 35(1) : 20-27
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Raha et al. (2020) studied this question.
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