Early and Mid-Term Impacts of Cardiopulmonary Bypass on Coronary Artery Bypass Grafting in Patients With Poor Left Ventricular Dysfunction A Propensity Score Analysis

Abstract

ff-pump coronary artery bypass grafting (OPCAB) is an alternative to conventional cardiopulmonary bypass-supported myocardial revascularization and is becoming increasingly popular, as it allows complete myocardial revascularization with excellent surgical results in most patients. 1,2 Severe left ventricular dysfunction has been reported to be an independent predictor of operative mortality in patients undergoing coronary artery bypass grafting (CABG) and patients with impaired left ventricular function undergoing revascularization on cardiopulmonary bypass (CPB) have increased mortality and morbidity when compared with patients with normal left ventricular function. [3][4][5] Left ventricular dysfunction also often leads to low cardiac output and a high postoperative morbidity, with many patients requiring inotropic or mechanical support, and vasopressors for hours to days after surgery. 6 It has been speculated that extracorporeal circulation may exacerbate myocardial damage in compromised left ventricles as a result of the activation of inflammatory mediators, the non-physiologic ventricular geometry of the empty heart impeding collateral flow to ischemic areas and worsened preservation of interventricular septal movement. 7,8 It may seem advisable to avoid cardiopulmonary bypass in patients with severe left ventricular dysfunction; however, many surgeons still choose conventional CABG using a CPB machine (On-pump CABG) due to hemodynamic instability concerns such as ventricular arrhythmia, hypotension and cardiac arrest during OPCAB. The present study evaluates the effects of cardiopulmonary bypass and the efficacy of OPCAB by comparing the short and mid term results of OPCAB and On-pump CABG in patients with severe left ventricular dysfunction with an analysis of a propensity score matching. Methods Patient SelectionFrom December 2000 through November 2005, 1,473 patients underwent isolated CABG without a concomitant operation-such as left ventricular volume reduction surgery, arrhythmia operation or valve surgery-at Yonsei Cardiovascular Center, Yonsei University College of Medicine. Preoperative and postoperative data were obtained using a Circ J 2007; 71: 1387 -1394 (Received March 8, 2007 revised manuscript received May 9, 2007; accepted June 5, 2007) Department of Thoracic Early and mid-term outcomes of off-pump coronary artery bypass grafting (OPCAB) vs on-pump coronary artery bypass grafting (On-pump CABG) were compared in patients with poor left ventricular dysfunction, using an analysis of a propensity score matching. Methods and ResultsBetween December 2000 and November 2005, 1,473 patients underwent isolated coronary artery bypass grafting in our institute and 153 patients who had a left ventricular ejection fraction (LVEF) lower than 35% were enrolled. The OPCAB group contained 100 patients and the On-pump CABG group contained 53 patients. Preoperative risk factors were compared and 50 patients in each group were matched. The mean follow-up time was 35.5±17.3 months. Three deaths (3.0%...

The influence of a low ejection fraction on long-term survival in systematic off-pump coronary artery bypass surgery

“…Death from non-cardiac causes was similar between the two groups (15.5%, n = 21) in the low LVEF group, compared with 10.2% (n = 112) in the normal LVEF group ( p = 0.13). Youn et al showed similar midterm results in patients with depressed LV function as OPCAB revascularization resulted in a survival rate of over 80% at 6 years [23]. Suzuki et al recently reported comparable midterm results, as the 5-year freedom from death from all causes was 57% in an OPCAB group of patients with a low LVEF.…”

Off-pump coronary bypass surgery for high-risk patients: only in expert centers?

“…Youn et al [30] also showed similar 6-year survival rates (88% in OPCAB versus 72% in ONCAB) and freedom from major adverse cardiovascular events.…”

“…Two recent comparisons of OPCAB and ONCAB in patients with LV dysfunction (defined as ejection fraction <35%) revealed a reduction in perioperative morbidity in OPCAB patients, specifically with respect to ICU LOS, respiratory failure, need for intotropes, and need for intraaortic balloon counterpulsation (IABP) [29,30]. Youn et al [30] also showed similar 6-year survival rates (88% in OPCAB versus 72% in ONCAB) and freedom from major adverse cardiovascular events.…”

Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia

“…65 In addition, the long-term results were improved by CABG with arterial grafts and complete revascularization in Asian countries as experienced in Western countries. 66,67 Hence, we need future research into whether widespread DES use will improve outcomes and save costs in the treatment of various subsets of coronary artery disease.…”