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OBJECTIVE: Off-pump coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction has been considered challenging. We assessed the early and mid-term clinical outcomes of patients with poor left ventricular function who underwent isolated off-pump CABG.
METHODS: We retrospectively reviewed records of 161 patients with poor left ventricular ejection fraction (LVEF≤40%) who underwent isolated off-pump CABG between September 2004 and July 2011. Mean age was 67.2 ± 11.4 years. Twenty patients (12.4%) were female. There were 88 patients (54.7%) with New York Heart Association functional class 3 or 4. Early postoperative angiograms (performed in 75.2% of patients) and echocardiograms (performed in 96.3% of patients) were evaluated during the same period of hospitalization. Interval angiograms (performed in 47.8% of patients; mean 13.6 ± 6.6 months postoperatively) and echocardiographic data (performed in 71.4% of patients; mean 21.9 ± 20.4 months postoperatively) were also analyzed, and mid-term survival rate (follow-up rate 100%; mean 40.7 ± 25.6 months postoperatively) was evaluated.
RESULTS: The mean number of distal anastomoses per patient was 4.4 ± 1.3. Bilateral internal thoracic artery grafts were used in 84.5% of patients. Operative mortality was 2.5%. Stroke occurred in 3.1% of patients. Early postoperative patency rate of anastomoses was 98.3%. Early postoperative LVEF improved from 33.0 ± 5.8% to 37.1 ± 9.7% (p <0.001). Actuarial survival rate, freedom from cardiac death rate, and freedom from cardiac event rate at 7 years was 73.9 ± 5.3%, 88.7 ± 4.1%, and 68.5 ± 5.2%, respectively. Interval patency rate of anastomoses was 85.8%. Interval LVEF was 39.0 ± 10.5% (p <0.001).
CONCLUSIONS: Off-pump CABG in patients with left ventricular dysfunction was safe and effective with favorable patency rates of anastomoses. Mid-term outcome was also acceptable with echocardiographic functional recovery.