Off-pump complete myocardia revascularization in low ejection fraction patients ( LVEF ≤ 35% ) : Surgical outlook and mid-term results of 762 consecutive patients

Objectives : to evaluate the mid-term results of 762 consecutive patients with Left Ventricular Ejection Fraction ( LVEF ) ≤ 35% who underwent off-pump complete myocardial revascularization. Methods : from Jan 2003 till July 2007, 762 patients with LVEF ≤ 35% out of 4828 consecutive myocardial revascularizations at the Asian Heart Institute have been monitored collecting data in a prospective study. Male: 85.2%; mean age: 61.1 years; unstable angina: 27.9%; recent ( 50% ): 12.5%; TVD: 84.16%; DVD: 10.9%; SVD: 1.9%. Mean EuroSCORE: 18; Average Anastomosis per patient: 4.28. Conduits : LIMA: 96.1%, RIMA: 15%, BIMA: 12.2%, RA: 82.3%, SVG: 13.8%. Intra or post-operative Intra Aortic Ballon Pump ( IABP ): 10.6%; IABP pre-operative: 3.88%. Transfusions: 42.2%. Routine Cell-Saver. Results : hospital mortality: 8 patients ( 1.04% ). Ventricular Failure: 5 patients; major stroke: 2; massive pulmonary embolism: 1. Mean stay in hospital: 9.93 days. Major complications: re-exploration for bleeding: 1.4%; arrhythmias: 8.5% ( AF: 5.6%, VT/VF: 1.96%, Other Ventricular: 0.9%, complete AV Block: 0.26%, Transient: 0.5%). Stroke: 0.5%. 4.6% patients with pre-existing Renal Dysfunction and 1.83% with normal Renal Function had Creatinine increase. Pre and post-operative Dialysis: 1.04%. Conversion to on pump: 2 cases. Late mortality: 35 patients ( 4.64%: Heart Failure: 23, CerebroVascular Accidents: 4, Progressive Renal Failure: 3, Unknown: 5 ). Pre and post-operative 2 D-Echo LVEF at 3, 6, 12, 24, 36 months in homogeneous groups have been statistically analysed with Standard Deviation and Confi dence Limits. The defi nitive value of these data, although promising in terms of improvement, has to be validated with long term results. Conclusions : off-pump complete total arterial myocardial revascularisation in LVEF patients can be achieved in most cases with low mortality, low complications rate and good intermediate results.