Off-Pump Surgery Is Not a Contraindication for Patients with a Severely Decreased Ejection Fraction

Abstract

<p><b>Background:</b> A severely impaired left ventricular ejection fraction (EF) (30%) increases the risk of surgical myocardial revascularization. We evaluated the safety and feasibility of off-pump coronary artery bypass (OPCAB) surgery in patients with a severely decreased EF.</p><p><b>Methods:</b> We compared 79 patients with an EF ?30% (group A) with 863 patients with an EF >30% (group B) who underwent myocardial revascularization between 2003 and 2008. The relationship between EF and outcome after OPCAB was assessed by univariate and logistic regression analyses. A composite end point was constructed from 30-day mortality, renal failure, length of stay in the intensive care unit (ICU) >2 days, neurologic complications, and use of an intra-aortic balloon pump (IABP). Additionally, the completeness of revascularization was assessed.</p><p><b>Results:</b> The mortality rates for groups A and B were comparable (1.3% and 2.0%, respectively; <i>P</i> = .55), and the 2 groups did not differ with regard to serious postoperative complications, such as stroke (2.5% versus 1.4% for groups A and B, respectively; <i>P</i> = .42), peripheral neurologic complications (2.5% versus 0.7%, <i>P</i> = .14), renal failure (0% versus 1.1%, <i>P</i> = 1.00), use of an IABP (1.3% versus 0.8%, <i>P</i> = .50), ICU length of stay >2 days (17.7% versus 19.6%, <i>P</i> = .77). Similarly, groups A and B did not differ with regard to ventilation time (11.2 � 12.7 hours versus 12.4 � 15.5 hours, <i>P</i> = .82), indicating similar postoperative courses for the 2 groups of patients. In contrast, the composite end point occurred significantly more frequently in group A (43.0% versus 29.7%, <i>P</i> = .02), a result driven by the increased rate of rethoracotomy for bleeding in that group (11.4% versus 2.9%, <i>P</i> = .001). The 2 groups were similar with respect to the total number of grafts used per patient (3.82 � 0.89 versus 3.63 � 1.01, <i>P</i> = .10) and the completeness of revascularization (94% versus 93%, <i>P</i> = .49).</p><p><b>Conclusion:</b> A standardized OPCAB approach is safe for patients with a severely decreased EF, and its use does not come at the cost of less complete revascularization.</p>