Onpump Versus Off pump Coronary Artery Bypass Grafting In Patients With Severe Left Ventricular Dysfunction
Ahmed Abdelaziz Mohammed1, BAYAN alshaikh2, Ahmed Dokhan3, Mohamed Gomaa4, Montaser El Sawy Abdelziz3.
1Cardiovascular and Thoracic Surgery Department, Dr Soliman Fakeeh Hospital, jeddah, Saudi Arabia, 2KFAFH, jeddah, Saudi Arabia, 3Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt, 4Cardiothoracic Surgery Department, Faculty Of Medicine, Cairo University, Cairo, Egypt.
Background: The aim of our study is to look for the best operative strategy for patients planned for coronary artery bypass grafting (CABG) with severe left ventricular dysfunctionMethods: Between January,2013 and July,2016 in an observational study we analyzed 79 patients with ejection fraction ≤35% who underwent primary, nonemergency, isolated CABG via median sternotomy. Patients divided into two groups; ONCAB (n=41;51.8%) and OPCAB (n=38;48.1%) . Diabetes mellitus, New York Heart Association (NYHA) classes, Euro-score, number of diseased vessels were significantly higher in ONCAB however, renal insufficiency was more in OPCAB. Other Preoperative variables were comparable in both groups . Results:Intra-operatively procedure time and number of grafts were significantly lower in OPCAB. Conversion rate for OPCAB was 2.6% .Post operative outcomes needs for inotropes, mechanical ventilation time, blood transfusion, and troponin release were significantly lower in OPCAB. While ,Hospital stay, in-hospital mortality, stroke, renal dysfunction, bleeding, re-exploration, deep sternal wound infection, and atrial fibrillation were comparable. Although , no significant difference was found in short term mortality, myocardial infarction, revascularization, readmission, renal or neurological dysfunction
Conclusions: OPCAB in patients with poor ventricular function is a safe and feasible technique with the potential advantage of the reduction of blood transfusion and pulmonary insufficiency. However , there was no difference in short term mortality when compared to ONCAB technique.
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