On- vs. Off-Pump CABG in Heart Failure Patients with Reduced Ejection Fraction (HFrEF): A Multicenter Analysis

Abstract

Objective: This study aimed to compare postoperative outcomes and 30-day mortality in patients with reduced ejection fraction (<40%) who underwent isolated coronary artery bypass grafting (CABG) with (ONCAB) and without (OPCAB) the use of cardiopulmonary bypass. Methods: data from four university hospitals in Germany, spanning from January 2017 to December 2021, were retrospectively analyzed. A total of 551 patients were included in the study, and various demographic, intraoperative, and postoperative data were compared. Results: demographic parameters did not exhibit any differences. However, the OPCAB group displayed notably higher rates of preoperative renal insufficiency, urgent surgeries, and elevated EuroScore II and STS score. During surgery, the ONCAB group showed a significantly higher rate of complete revascularization, whereas the OPCAB group required fewer intraoperative transfusions. No disparities were observed in 30-day/in-hospital mortality for the entire cohort and the matched population between the two groups. Subsequent to surgery, the OPCAB group demonstrated significantly shorter mechanical ventilation times, reduced stays in the intensive care unit, and lower occurrences of ECLS therapy, acute kidney injury, delirium, and sepsis. Conclusions: the study’s findings indicate that OPCAB surgery presents a safe and viable alternative, yielding improved postoperative outcomes in this specific patient population compared to ONCAB surgery. Despite comparable 30-day/in-hospital mortality rates, OPCAB patients enjoyed advantages such as decreased mechanical ventilation durations, shorter ICU stays, and reduced incidences of ECLS therapy, acute kidney injury, delirium, and sepsis. These results underscore the potential benefits of employing OPCAB as a treatment approach for patients with coronary heart disease and reduced ejection fraction.

Unraveling the Predictors for Delirium and ICU Stay Duration in Patients with Heart Failure and Reduced Ejection Fraction (HFrEF) Undergoing Coronary Artery Bypass Grafting—A Multicentric Analysis

“…A comprehensive analysis and explanation of the surgical methods employed in this study, specifically ONCAB and OPCAB, along with their respective techniques and protocols, have been thoroughly presented in a preceding publication. For a detailed exploration of these methodologies, we direct readers to consult our earlier work [9].…”

“…ONCAB is traditionally linked to increased systemic inflammatory responses and organ hypoperfusion, potentially heightening the risk of POD and extended ICU stays [3,8]. In contrast, OPCAB, by circumventing cardiopulmonary bypass, is thought to mitigate these risks [9]. However, the relative benefits and safety of OPCAB, especially in the HFrEF cohort, demand further critical evaluation and empirical substantiation.…”

Influence of Obesity on Short-Term Surgical Outcomes in HFrEF Patients Undergoing CABG: A Retrospective Multicenter Study

“…The detailed description of the surgical CABG procedures (ONCAB and OPCAB), including specific techniques and protocols, is extensively elaborated in our prior study. For an in-depth understanding of these surgical methodologies, readers are encouraged to refer to that publication [9].…”