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Early and mid-term impacts of cardiopulmonary bypass on coronary artery bypass grafting in patients with poor left ventricular dysfunction: a propensity score analysis.

AbstractBACKGROUND:
Cardiopulmonary bypass may exacerbate myocardial damage in compromised left ventricles. Early and mid-term outcomes of off-pump coronary artery bypass grafting (OPCAB) vs on-pump coronary artery bypass grafting (On-pump CABG) were compared in patients with poor left ventricular dysfunction, using an analysis of a propensity score matching.
METHODS AND RESULTS:
Between December 2000 and November 2005, 1,473 patients underwent isolated coronary artery bypass grafting in our institute and 153 patients who had a left ventricular ejection fraction (LVEF) lower than 35% were enrolled. The OPCAB group contained 100 patients and the On-pump CABG group contained 53 patients. Preoperative risk factors were compared and 50 patients in each group were matched. The mean follow-up time was 35.5+/-17.3 months. Three deaths (3.0%) occurred in the matched cohort, with no significant difference between 2 groups. The operation time, ventilation time, intensive care unit admission time and occurrence of respiratory failure were significantly lower in the OPCAB group. The mean LVEF of the 2 groups improved significantly. The overall 6-year actuarial survival rates of the OPCAB and On-pump CABG group were 88.2% and 72.4% (p=0.2), respectively, and there were no significant differences in 6-year rates of freedom from major adverse cardiac and cerebrovascular events (p=0.97).
CONCLUSIONS:
Coronary artery bypass grafting in patients with poor left ventricular dysfunction improved myocardial function. Postoperative respiratory failure was significantly related to the cardiopulmonary bypass for surgical myocardial revascularization. Off-pump and On-pump surgical revascularization resulted in equivalent mid-term outcomes.
AuthorsYoung-Nam Youn, Byung-Chul Chang, You-Sun Hong, Young-Lan Kwak, Kyung-Jong Yoo
JournalCirculation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 71 Issue 9 Pg. 1387-94 (Sep 2007) ISSN: 1346-9843 [Print] Japan
PMID17721016 (Publication Type: Comparative Study, Journal Article)
Topics
  • Aged
  • Cardiopulmonary Bypass
  • Coronary Artery Bypass
  • Critical Care
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Postoperative Period
  • Respiratory Insufficiency (etiology, mortality)
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Time Factors
  • Ventricular Dysfunction, Left (complications, mortality, surgery)

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