Surgical revascularization in patients with poor left ventricular function: on- or off-pump?

Background Patients with left ventricular dysfunction and low ejection fraction (EF) are at high-risk of complication and mortality after coronary artery bypass grafting (CABG). The potential success of off-pump CABG in this high-risk population has yet to be determined. The purpose of this study is to compare the outcome of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass (CCAB) in patients with poor left ventricular function, all from a single institution. Methods Data on patient demographics, preoperative risk factors, operative and postoperative outcomes were collected retrospectively on all patients having undergone isolated CABG between January 1, 1998, and October 31, 2001. Results A total of 77 patients (31 OPCAB/46 CCAB) were identified as having an ejection fraction (EF) of ≤0.35. Of these, 52 had EF ≤ 0.30 (21 OPCAB/31 CCAB) and 31 patients had EF ≤ 0.25 (10 OPCAB/21 CCAB). Operative mortality was 3.2% after the OPCAB procedure versus 10.9% for the CCAB (p = 0.39). Use of intraaortic balloon pump (6.5%) was rarely required. The OPCAB procedure resulted in significantly less requirement for blood transfusions (p< 0.05), fewer distal anastomoses per patient (p< 0.01), and a higher incidence of atrial fibrillation (p< 0.05) compared with CCAB. Conclusions Patients with poor left ventricular function may undergo surgical revascularization using off-pump technique with relatively good results and low mortality levels. The lower number of grafts performed on the off-pump procedure did not seem to affect clinical outcomes.