Impact of severe left ventricular dysfunction on in-hospital and mid-term outcomes of Chinese patients undergoing first isolated off-pump coronary artery bypass grafting

Abstract

Background: Few studies focused on evaluating the impacts of preoperative severe left ventricular dysfunction on clinical outcomes of patients undergoing off-pump coronary artery bypass grafting surgery (OPCAB). This single center retrospective study aimed to evaluate the impacts of severe left ventricular dysfunction on in-hospital and mid-term clinical outcomes of Chinese patients undergoing first, scheduled, and isolated OPCAB surgery. Methods: From January 2010 to December 2014, 2032 eligible patients were included in this study and were divided into 3 groups: a severe group (patients with preoperative left ventricular ejection fraction (LVEF) of ≤35%, n = 128), an impaired group (patients with preoperative LVEF of 36-50%, n = 680), and a normal group (patients with preoperative LVEF of >50%, n = 1224). In-hospital and follow-up clinical outcomes were investigated and compared. Results: Patients in the severe group compared to the other 2 groups had higher in-hospital mortality and higher incidences of low cardiac output and prolonged ventilation. Kaplan-Meier curves showed a similar cumulative follow-up survival between the severe group and the impaired group (χ 2 = 1.980, Log-rank p = 0.159) and between the severe group and the normal group (χ 2 = 2.701, Log-rank p = 0.102). Multivariate Cox regression indicated that grouping was not a significant variable related to mid-term all-cause mortality. No significant difference was found in the rate of repeat revascularization between the severe group (2.4%) and the other 2 groups. Conclusions: Patients with preoperative LVEF of ≤35% compared to preoperative LVEF of >35% increased the risk of in-hospital death and incidences of postoperative low cardiac output and prolonged ventilation, but shared similar mid-term all-cause mortality and repeat revascularization after OPCAB surgery.

Outcomes of Coronary Artery Disease Patients with Severe Left Ventricular Dysfunction Undergoing Surgical Management

“…The 30-day mortality in a similar study in patients from the Indian subcontinent by Jose et al was 11.62%. The 30-day mortality was comparable with those in other studies conducted in the western world [Elefteriades 1997;Davoodi 2012;Ji 2017]. The mean survival time was significantly less for the CABG with mitral valve repair group.…”

“…The group with LVED <30% had a higher incidence of diabetes mellitus, COPD, peripheral vascular disease, prior MI, and fewer elective procedures compared with the group with LVEF >30%. The occurrence of respiratory (14.8% versus 1.9%, P < .001), renal (5.2% versus 1.0%, P < .001), and vascular (5.2% versus 0.5%, P < .001) complications was highly significant in the LV dysfunction group with a longer hospital stay (8 +8 versus 6 + 4 days, P < .0001) [Ji 2017].…”

Two novel nomograms predict 30-day mortality after off-pump coronary artery bypass grafting

“…Compared with the SinoScore and ACEF II, the use of direct creatinine levels to predict postoperative mortality in our study is superior to creatinine >176 μmol/L (2 mg/dL). Several studies have found that left ventricular dysfunction will increase the risk of postoperative mortality [ 5 , 6 , 25 ].…”