Key result
Off-pump CABG linked to ~43% lower operative mortality versus conventional bypass in patients with EF ≤35%.
Why the study?
Surgical risk and early morbidity and mortality remain high among patients with left ventricular dysfunction undergoing myocardial revascularization, necessitating evaluation of pump technique effects.
Does off-pump coronary artery bypass reduce early morbidity and mortality compared to conventional on-pump bypass in patients with ejection fraction ≤35%?
Cohort (n=150)
Does off-pump coronary artery bypass reduce early morbidity and mortality compared to conventional on-pump bypass in patients with ejection fraction ≤35%?
Absolute Event Rate: 6.1% vs 10.7%
In patients with EF ≤35%, off-pump CABG is associated with lower early mortality and morbidity compared to on-pump CABG, despite achieving less complete revascularization.
May support off-pump CABG in low-EF patients; leaves open need for randomized confirmation.
BACKGROUND AND AIM: Left ventricular dysfunction is an important predictor of in-hospital mortality. Surgical risk among these patients remains high. The present study is conducted to evaluate the difference in early morbidity and mortality among patients with compromised left ventricular function (LVF) after myocardial revascularization using either off-pump or on-pump coronary artery bypass graft. METHODS: Between April 2000 and April 2004, 150 patients with ejection fraction (EF) < or =35% underwent isolated coronary artery bypass grafting. Eighty-four patients underwent conventional bypass (mean EF 30.1%+/- 4.2) and 66 patients had off-pump coronary artery bypass (mean EF 27.5%+/- 5.5). Different variables (preoperative, intraoperative, and postoperative) were evaluated and compared. Determination of operation risk was done using EuroSCORE. Patients who underwent OPCAB were more risky due to a high percentage of associated comorbidities, mean EuroSCORE was 12.96 +/- 13.21 in comparison to 8.47 +/- 10.22 in CCAB. RESULTS: The mean operative mortality was 8.7%. Patients who underwent OPCAB had a lower operative mortality than CCAB (6.1% vs. 10.7%) inspite of a higher preoperative predicted risk score. Completeness of revascularization was higher among the CCAB group (85.7% vs. 69.7%; p = 0.01). Subsequently, the mean number of grafts was significantly higher among this group (3.4+/-0.7 vs. 2.0 +/-0.9; p < 0.001). On the other hand, morbidity was significantly higher in CCAB (35.7% vs. 19.7%; p = 0.03). However, the incidence of both myocardial infarction and atrial fibrillation was more among OPCAB. CONCLUSIONS: Patients with left ventricular dysfunction are high-risk group. These patients can benefit from myocardial revascularization using either off-pump or conventional CABG, but both are associated with a higher mortality and morbidity than those with normal ventricle. The use of off-pump CABG resulted in better clinical outcome and mortality, but less number of grafts performed than those with conventional CABG especially in patients with lowest EF.
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Darwazah et al. (2006) conducted a cohort in left ventricular dysfunction (ejection fraction ≤35%) requiring coronary artery bypass grafting (n=150). Off-pump coronary artery bypass (OPCAB) vs. Conventional coronary artery bypass (CCAB) was evaluated on operative mortality. Off-pump coronary artery bypass was associated with lower operative mortality (6.1% vs. 10.7%) and morbidity (19.7% vs. 35.7%; p=0.03) compared to conventional bypass in patients with EF ≤35%.
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