Off-pump coronary bypass surgery is safe in patients with a low ejection fraction (≤25%)

Maximilian Y. Emmert, Lorenz S. Emmert, Eliana Cecilia Martinez Valencia, Chuen N. Lee, Theo Kofidis

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: A severely decreased ejection fraction (EF) of ≤25% is an established risk factor for a worse outcome after heart surgery and therefore has been incorporated into the EuroSCORE risk-stratification model. We compare clinical outcomes after off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting in patients with a severely compromised EF. Methods: We compared 112 patients with a low EF (≤25%) who underwent myocardial revascularization between 2003 and 2008. Forty-four patients underwent OPCAB (group A), and 68 patients underwent on-pump surgery (group B). We compared demographics, intraoperative parameters, intraoperative outcomes, and the completeness of revascularization for the 2 groups. Results: Demographic and EuroSCORE data were comparable for groups A and B. The 2 groups appeared to be similar with respect to mortality rate during the first 30 days (2.2% and 8.8%, respectively; P = .11) and the rate of major complications such as stroke (2.2% and 2.9%, respectively; P = 0.83). The patients in group A had fewer pulmonary complications (7% versus 25%, P < .01), received fewer blood transfusions (15.9% versus 47.0%, P < .01), required fewer postoperative pacing procedures (atrial, 11.4% versus 39.7%; ventricular, 13.6% versus 47.1%; P < .01), and had fewer wound infections (2.2% versus 16.1%, P = .02). The numbers of diseased vessels were comparable, and although the OPCAB patients received more arterial grafts (1.05 ± 0.43 versus 0.84 ± 0.37, P < .01), the total number of grafts per patient was lower among these patients (2.50 ± 0.88 versus 3.53 ± 0.92, P = .03). Similarly, complete revascularization was achieved less frequently within this group (80% versus 94%, P = .02). Conclusions: A standardized OPCAB approach in patients with a severely decreased EF is safe and may benefit this subset of patients with respect to fewer postoperative complications. Although complete revascularization is the optimal approach for these patients, they benefit from avoiding cardiopulmonary bypass.

Original languageEnglish (US)
JournalHeart Surgery Forum
Volume13
Issue number3
DOIs
StatePublished - Jun 2010
Externally publishedYes

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Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Demography
Transplants
Myocardial Revascularization
Postoperative Care
Wound Infection
Cardiopulmonary Bypass
Blood Transfusion
Thoracic Surgery
Stroke
Lung
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Off-pump coronary bypass surgery is safe in patients with a low ejection fraction (≤25%). / Emmert, Maximilian Y.; Emmert, Lorenz S.; Martinez Valencia, Eliana Cecilia; Lee, Chuen N.; Kofidis, Theo.

In: Heart Surgery Forum, Vol. 13, No. 3, 06.2010.

Research output: Contribution to journalArticle

Emmert, Maximilian Y. ; Emmert, Lorenz S. ; Martinez Valencia, Eliana Cecilia ; Lee, Chuen N. ; Kofidis, Theo. / Off-pump coronary bypass surgery is safe in patients with a low ejection fraction (≤25%). In: Heart Surgery Forum. 2010 ; Vol. 13, No. 3.
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abstract = "Background: A severely decreased ejection fraction (EF) of ≤25{\%} is an established risk factor for a worse outcome after heart surgery and therefore has been incorporated into the EuroSCORE risk-stratification model. We compare clinical outcomes after off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting in patients with a severely compromised EF. Methods: We compared 112 patients with a low EF (≤25{\%}) who underwent myocardial revascularization between 2003 and 2008. Forty-four patients underwent OPCAB (group A), and 68 patients underwent on-pump surgery (group B). We compared demographics, intraoperative parameters, intraoperative outcomes, and the completeness of revascularization for the 2 groups. Results: Demographic and EuroSCORE data were comparable for groups A and B. The 2 groups appeared to be similar with respect to mortality rate during the first 30 days (2.2{\%} and 8.8{\%}, respectively; P = .11) and the rate of major complications such as stroke (2.2{\%} and 2.9{\%}, respectively; P = 0.83). The patients in group A had fewer pulmonary complications (7{\%} versus 25{\%}, P < .01), received fewer blood transfusions (15.9{\%} versus 47.0{\%}, P < .01), required fewer postoperative pacing procedures (atrial, 11.4{\%} versus 39.7{\%}; ventricular, 13.6{\%} versus 47.1{\%}; P < .01), and had fewer wound infections (2.2{\%} versus 16.1{\%}, P = .02). The numbers of diseased vessels were comparable, and although the OPCAB patients received more arterial grafts (1.05 ± 0.43 versus 0.84 ± 0.37, P < .01), the total number of grafts per patient was lower among these patients (2.50 ± 0.88 versus 3.53 ± 0.92, P = .03). Similarly, complete revascularization was achieved less frequently within this group (80{\%} versus 94{\%}, P = .02). Conclusions: A standardized OPCAB approach in patients with a severely decreased EF is safe and may benefit this subset of patients with respect to fewer postoperative complications. Although complete revascularization is the optimal approach for these patients, they benefit from avoiding cardiopulmonary bypass.",
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AU - Emmert, Maximilian Y.

AU - Emmert, Lorenz S.

AU - Martinez Valencia, Eliana Cecilia

AU - Lee, Chuen N.

AU - Kofidis, Theo

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N2 - Background: A severely decreased ejection fraction (EF) of ≤25% is an established risk factor for a worse outcome after heart surgery and therefore has been incorporated into the EuroSCORE risk-stratification model. We compare clinical outcomes after off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting in patients with a severely compromised EF. Methods: We compared 112 patients with a low EF (≤25%) who underwent myocardial revascularization between 2003 and 2008. Forty-four patients underwent OPCAB (group A), and 68 patients underwent on-pump surgery (group B). We compared demographics, intraoperative parameters, intraoperative outcomes, and the completeness of revascularization for the 2 groups. Results: Demographic and EuroSCORE data were comparable for groups A and B. The 2 groups appeared to be similar with respect to mortality rate during the first 30 days (2.2% and 8.8%, respectively; P = .11) and the rate of major complications such as stroke (2.2% and 2.9%, respectively; P = 0.83). The patients in group A had fewer pulmonary complications (7% versus 25%, P < .01), received fewer blood transfusions (15.9% versus 47.0%, P < .01), required fewer postoperative pacing procedures (atrial, 11.4% versus 39.7%; ventricular, 13.6% versus 47.1%; P < .01), and had fewer wound infections (2.2% versus 16.1%, P = .02). The numbers of diseased vessels were comparable, and although the OPCAB patients received more arterial grafts (1.05 ± 0.43 versus 0.84 ± 0.37, P < .01), the total number of grafts per patient was lower among these patients (2.50 ± 0.88 versus 3.53 ± 0.92, P = .03). Similarly, complete revascularization was achieved less frequently within this group (80% versus 94%, P = .02). Conclusions: A standardized OPCAB approach in patients with a severely decreased EF is safe and may benefit this subset of patients with respect to fewer postoperative complications. Although complete revascularization is the optimal approach for these patients, they benefit from avoiding cardiopulmonary bypass.

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