Key result
Severely reduced LVEF linked to ~13-point higher post-OPCAB composite morbidity despite comparable 30-day mortality.
Why the study?
A severely impaired left ventricular EF (30%) increases the risk of surgical myocardial revascularization, prompting an evaluation of the safety and feasibility of OPCAB surgery in patients with a severely decreased EF.
Cohort (n=942)
Answers are grounded in this paper and cite their sources.
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). CONCLUSION: 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.
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Emmert et al. (2011) conducted a cohort in Patients undergoing off-pump coronary artery bypass (OPCAB) surgery with or without severely decreased left ventricular ejection fraction (n=942). Severely decreased ejection fraction (EF ≤30%) in OPCAB vs. Ejection fraction >30% in OPCAB was evaluated on Composite of 30-day mortality, renal failure, ICU length of stay >2 days, neurologic complications, and use of an intra-aortic balloon pump (IABP) (also incorporating rethoracotomy for bleeding) (p=.02). Severely decreased EF in OPCAB patients had comparable 30-day mortality to EF >30%, though the composite endpoint was higher.
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