Off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction

Abstract

Objective: Off-pump coronary artery bypass grafting (OPCAB) is known to preserve left ventricular function better than conventional coronary artery bypass grafting (CCAB). This study was carried out to investigate the safety, feasibility and efficacy of off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction. Methods: Three hundred and eighty eight consecutive patients with preoperative left ventricular ejection fraction ≤ 39% who underwent CABG between January 2001 through October 2007 were included in this retrospective study. Two hundred and eleven patients were operated by off-pump technique (group 1) and 178 patients were operated by on-pump technique (CCAB) (group 2). The postoperative outcomes were analyzed. Of these, 204 (52. 57%) patients were diabetics, 355 (91. 49%) patients had documented prior myocardial infarction, 316 (81. 44%) patients were in canadian cardiovascular society(CCS) class III and 47 (12. 11%) patients were in CCS class IV. Results: There was no significant difference in the number of grafts per patient between the two groups [group 1 3. 02 ± 0. 76 vs group 2 3. 18 ± 0. 72 (P=0. 07) and the index of completeness of revascularization was comparable [1. 08 ± 0. 08) (OPCAB) vs 1. 04 ± 0. 06 (CCAB) (p=0. 52)] The left internal thoracic artery was anastomosed to left anterior descending artery in 98% of patients. Operative mortality was 2. 8% (6 deaths) following OPCAB and 3. 93% (7 deaths) following CCAB (p=0746). Postoperative usage of IABP support was higher in CCAB group (12 patients vs 4 patients: P<0. 03) and usage of moderate or higher doses of inotropic support was also higher in the conventional group (p<0. 0006). More worsening of preexisting renal insufficiency was observed in CCAB group (p=0. 01) and no significant difference in the incidence of atrial fibrillation was observed between the groups. Conclusions: Off-pump coronary artery bypass grafting is feasible and safe in patients with depressed left ventricular function and the postoperative morbidity was less in OPCAB group compared to on-pump group. © 2008 Indian Association of Cardiovascular-Thoracic Surgeons.