OPCAB surgery : a critical review of two different categories of pre-operative ejection fraction

Objective: Literature review found little information on off-pump coronary artery bypass (OPCAB) procedure in patients with poor left ventricular function and there was no information comparing the low EF and normal EF patients undergoing OPCAB procedure. Methods: Between 1/1/1998 and 6/30/1999, 387patients had surgery performed utilizing the off-pump technique and 45 of these patients had pre-operative left ventricular function of equal to or less than 30% (LVEF ≤30). The two groups (LVEF ≤30 and LVEF > 30) were compared using univariate analysis. Patients in LVEF ≤30 were older and more female gender. LVEF 30. Pre-operative predicted risk was 6.4 ± 5.5% in LVEF ≤30 and 2.7 ± 4.5% in LVEF > 30 (P 95%) of the patients in both groups were elective status, and LVEF ≤30 patients had increased incidence of redo (11 vs. 6%, P = 0.2). In LVEF > 30, 84% of the patients had stable angina while only 69% in LVEF ≤30 (P = 0.009). Results: Intra-operatively no significant differences were measured in number of grafts per patient (2.7 vs. 2.8), amount of blood loss, peak CK-MB, skin-to-skin time, or OR time. Patients with LVEF ≤30 have more frequent utilization IABP during pre, intra and post-operative period. The statistical analysis yields no significance in post-operative major neurological deficit between these two groups; and are comparative to the nationally reported incidence of neurological deficit for on-pump patients. The operative mortality in the low EF group was 4.4 and 1.8% in LVEF > 30 group (P = 0.23). Conclusions: Given the clinical presentation of the low EF group, higher prediction risk, longer pre-operative stay, and length of ventilation (24 vs. 8 h P = 0.12) a longer surgery to discharge stay (8 vs. 6 days, P = 0.02) is anticipated. Short-term clinical outcomes for both groups of OPCAB patients encouraged us to continue to offer this approach to this broad base of patient population. All rights reserved.