Midterm outcome of off‐pump CABG for severe LV dysfunction—Does LV size and function predict their midterm outcome?

Abstract

Background The superiority of surgical revascularization in ischemic cardiomyopathy is established beyond doubt, and off‐pump CABG (OP‐CABG) is a safe way of revascularization in this high‐risk subset. Data on the effect of postoperative ventricular function and size on their midterm outcome is scarce. Materials and Methods A retrospective study was done on 211 consecutive patients with severe LV dysfunction who underwent OP‐CABG from January 2017 to December 2018. Data were collected from the institutional database. Their operative and midterm outcomes were statistically analyzed. Results The mean age of the cohort was 58.4 ± 8.3 years. An average number of grafts was 3.1 ± 0.8 (cumulative intended number of grafts—3). Operative mortality was 10.9%. Preoperative NYHA class (p < .0001; OR, 19.72) and postoperative IABP insertion (p < .008; OR, 88.75) were independent predictors of operative mortality. The mean follow‐up period was 3.14 ± 0.07 years, was 97.4% complete with cardiac mortality of 5.8%. Postoperative LVEF (p = .002; OR, 0.868) and LV dimensions (systole & diastole) (p = .013, OR = 1.182 and p = .036, OR = 1.184, respectively) were independent predictors of midterm mortality. Midterm major adverse cardiovascular event‐free survival of operative survivors was 89%. There was no correlation between postoperative LV dimension and NYHA status(p > .05). Myocardial viability was not associated with early (p = .17) or midterm mortality (p = .676). Conclusion OP‐CABG can achieve complete revascularization in patients with severe LV dysfunction with good midterm outcomes, albeit with high early operative mortality. Postoperative change in LV dimension and EF are predictors of midterm mortality.

Response to letter to the editor: “Toward the more justified strategy in off‐pump coronary bypass grafting for patients with severely reduced left ventricular function” by Fukonaga et al.

“…Nevertheless, according to the experience of Fukunaga et al and the recent study by Ananthanarayanan et al, 3 we support the position that preoperative LV dimensions should be taken into account when choosing the preferable surgical revascularization strategy for a patient. We need to make individual and tailor-made decisions when to perform on-or off-pump surgery.…”

Off‐pump coronary artery bypass in patients with severe LV dysfunction. Is it really more challenging?

“…In a recent report by Ananthanarayanan et al, 14 the team presented their experience with off‐pump CABG on a large cohort of patients with ischemic cardiomyopathy and severe left ventricular dysfunction. In this study, they included 211 patients with severe left ventricular (LV) dysfunction that underwent off‐pump CABG and were able to identify some key points.…”