Early and Medium Outcomes of On-Pump Beating-Heart versus Off-Pump CABG in Patients with Moderate Left Ventricular Dysfunction

Abstract

Objective This study aims to compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. Methods This is a retrospective study of ischemic heart disease patients with LVEF between 30% and 40% who underwent surgical revascularization from January 2013 to December 2017. Patients were divided into OPBH group (n=44) and OPCABG group (n=68), according to the surgical method. Clinical material with early and medium outcomes were investigated and compared between these groups. Results The two groups had similar baseline. Two OPBH patients and 3 OPCABG patients died in the hospital, which had no statistical significance ( P >0.05). OPBH patients received a greater number of grafts (3.74±0.84) and presented more improved LVEF (45.92±7.11%) than OPCABG patients (3.36±0.80) and (42.81±9.29%), respectively, which had statistical significance ( P <0.05). An increased amount of drainage during the first 12 hours was found in the OPBH group ( P <0.05). Reoperation for bleeding, duration of mechanic ventilation, and other early outcomes had no statistical significance between the two groups. During the medium-time follow-up, OPBH patients showed significantly lower major adverse cardiovascular events (MACE)-free survival time ( P =0.049) than OPCABG patients. Conclusion The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better mid-term MACE-free survival compared with OPCABG.

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

“…Furthermore, the anaortic or "no touch" approach 41,42 18 Our systematic review suggests that patients with reduced LVEF can benefit from OPBHC. 10,18,20,[24][25][26] Generalized data from all-comers population might support the idea of using OPBHC also in unselected patients. 7,15,19,23 Certainly, this hypothesis should be adequately investigated in future clinical trials.…”

“…Scientific evidence on the topic derives from retrospective observational studies mainly focused on high-risk patients. Literature search yielded a total of 279 records, and 17 studies 7,10,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28] and two meta-analyses 29,30 published between 2000 and 2020 were finally included in the systematic review (PRISMA flow diagram, Figure 1). Quality assessment is shown in Table 2; study characteristics and collected outcomes are summarized in Tables 3 and 4 and described below.…”

“…OPBHC technique is an effective method to perform surgical myocardial revascularization in high-risk patients. 10,13,[16][17][18][20][21][22][24][25][26][27][28] Elective use of OPBHC can be considered as a measure to prevent the hemodynamic deterioration and guarantee adequate end-organ (Table 7).…”

“…In this setting, emergent intraoperative conversion to on-pump CABG is a life-saving procedure, nevertheless it is associated with up to seven-fold increased risk of mortality (OR, 6.99, 95% CI, 5.18-9.45) 33 and a crude mortality rate of about 40%. 10 Although it occurs rarely with an incidence of 5% to 7%, 10 the risks associated with an emergency establishment of CPB can be avoided with OPBHC. Moreover, OPBHC with full cardiopulmonary assistance reduces ventricular volume loading in comparison to off-pump CABG.…”

“…This will provide intraoperative hemodynamic stability without aortic cross-clamp and cardioplegic cardiac arrest. 10 Patient selection remains a crucial aspect and in experienced hands OPBHC might avoid intraoperative complications or provide adequate revascularization even in high-risk patients. This systematic review and meta-analysis intends to summarize the contemporary literature in this field and point out strategies for current surgical practice and future research.…”