Early and midterm outcome after off-pump coronary artery bypass grafting in patients with poor left ventricular function compared with patients with normal function.

OBJECTIVE

As there are few reports on the clinical results of off-pump coronary artery bypass (OPCAB) in patients with poor left ventricular (LV) function, the safety and efficacy of OPCAB surgery in such patients remains unclear.

METHODS

From January 2002 to May 2007, a total of 519 consecutive patients underwent isolated myocardial revascularization via OPCAB. We compared the early and midterm results of 79 patients with poor LV function [ejection fraction (EF) < 40%] with those of 319 patients with normal LV function (EF >or= 50%). Follow-up was completed in 96.2% of the patients.

RESULTS

There were no significant intergroup differences in the number of grafts per patient or the rate of achievement of complete revascularization. No patient in either group was converted from off-pump to on-pump. The overall 30-day mortality was 1.0%. The mean follow-up was 3.0 +/- 1.3 years. Five-year freedom from death from all causes was 57.7% in the low-EF group and 83.6% in the normal-EF group. The rates of freedom from cardiac death were 73.2% and 93.7%, respectively; and the rates of freedom from the combined endpoint of cardiac death, myocardial infarction, repeat coronary intervention, and heart failure requiring treatment were 65.7% and 77.3%, respectively.

CONCLUSION

OPCAB surgery in patients with poor LV function can be performed safely with the same quality in terms of the number of grafts and rate of complete revascularization as in patients with normal LV function. There are higher mortality and cardiac event rates in patients with poor LV function than those with normal LV function at the midterm evaluation after OPCAB.