Off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction |
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Authors: | Lokeswara Rao Sajja Gopichand Mannam Satya Bhaskar Raju Dandu Satyendra Nath Pathuri Krishnamurthy Venkata Sathya Shiva Saikiran Sriramulu Sompalli |
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Institution: | (1) Division of Cardiothoracic Surgery, CARE Hospital, The Institute of Medical Sciences, Road no. 1, Banjara Hills, Hyderabad, 500034, AP, India;(2) Division of Cardiac Anesthesiology, CARE Hospital, The Institute of Medical Sciences, Banjara Hills, Hyderabad, India |
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Abstract: | Objective Off-pump coronary artery bypass grafting (OPCAB) is known to preserve left ventricular function better than conventional coronary
artery bypass grafting (CCAB). This study was carried out to investigate the safety, feasibility and efficacy of off-pump
coronary artery bypass grafting in patients with significant left ventricular dysfunction.
Methods Three hundred and eighty eight consecutive patients with preoperative left ventricular ejection fraction ≤ 39% who underwent
CABG between January 2001 through October 2007 were included in this retrospective study. Two hundred and eleven patients
were operated by off-pump technique (group 1) and 178 patients were operated by on-pump technique (CCAB) (group 2). The postoperative
outcomes were analyzed. Of these, 204 (52.57%) patients were diabetics, 355 (91.49%) patients had documented prior myocardial
infarction, 316 (81.44%) patients were in canadian cardiovascular society(CCS) class III and 47 (12.11%) patients were in
CCS class IV.
Results There was no significant difference in the number of grafts per patient between the two groups group 1 3.02 ± 0.76 vs group
2 3.18 ± 0.72 (P=0.07) and the index of completeness of revascularization was comparable 1.08 ± 0.08) (OPCAB) vs 1.04 ± 0.06
(CCAB) (p=0.52)] The left internal thoracic artery was anastomosed to left anterior descending artery in 98% of patients.
Operative mortality was 2.8% (6 deaths) following OPCAB and 3.93% (7 deaths) following CCAB (p=0746). Postoperative usage
of IABP support was higher in CCAB group (12 patients vs 4 patients: P<0.03) and usage of moderate or higher doses of inotropic
support was also higher in the conventional group (p<0.0006). More worsening of preexisting renal insufficiency was observed in CCAB group (p=0.01) and no significant difference in the incidence of atrial fibrillation was observed between the groups.
Conclusions Off-pump coronary artery bypass grafting is feasible and safe in patients with depressed left ventricular function and the
postoperative morbidity was less in OPCAB group compared to on-pump group. |
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Keywords: | Coronary artery bypass grafting OPCAB Cardiopulmonary bypass |
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