Short Term Outcome of Off Pump Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

Coronary artery disease is increasing in developing countries. Revascularization surgery in such patients with amenable coronary anatomy is a valid option. Coronary artery bypass grafting in patients with low ejection fraction (EF <35%) is very challenging although it is performing successfully in department of Cardiac Surgery of Bangabandhu Sheikh Mujib Medical University now a days. The purpose of this study is to evaluate the safety and effectiveness of off pump coronary artery bypass grafting for EF e”35% and EF <35% and also to compare between pre and postoperative echocardiographic findings in this two groups. The preoperative, at discharge, 1 month and 3 month postoperative follow up data of total 60 patients in two groups ( EF e”35% and <35%) who underwent isolated off pump coronary artery bypass grafting between July 2012 – June 2014 was evaluated. In group 1 preoperative LVIDd and LVIDs was 54.86±3.45 mm and 45.23 ±4.13mm and LVEF was 42.7±4.66. Postoperatively at 3 month follow up the LVIDd 45.43±5.03 mm, LVIDs 34.7±5.33 mm and LVEF 53.46±5.06. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. But improvement of LVEF is not statistically significant (p>0.05). Similarly in group 2 patients preoperative LVIDd, LVIDs and LVEF is 67.06±3.67mm, 59.1±4.35mm and 29.26±4.25. Postoperatively at 3 months follow up of this group the LVIDd, LVIDs and LVEF is changed to 57.56±4.96 mm, 48.3±5.53 mm and 38.93±6.03. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. And the improvement of LVEF is also statistically significant (p<0.001). Significant improvement in terms of CCS grade and NYHA class was also observed specially in <35% ejection fraction group at 3moths follow up. We concluded that off pump coronary artery bypass grafting can be safely performed to the patients with normal and poor left ventricular ejection. Hence we recommended that off-pump CABG can be safely carry out in case of <35% ejection fraction patients. University Heart Journal Vol. 14, No. 2, Jul 2018; 53-61

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Ten-Year Outcome Analysis of Off-Pump Sequential Grafting: Single Surgeon, Single Center Experience

The Heart Surgery Forum ◽

10.1532/hsf98.20111087 ◽

2012 ◽

Vol 15 (3) ◽

pp. 136 ◽

Cited By ~ 2

Author(s):

Shahzad G. Raja ◽

Kareem Salhiyyah ◽

Manoraj Navaratnarajah ◽

Muhammad Umar Rafiq ◽

Jeremy Felderhof ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Medium Term ◽

Artery Bypass Grafting ◽

Off Pump ◽

Pump Coronary Artery Bypass

Objectives: Despite increasing recognition that off-pump coronary artery bypass surgery and sequential grafting strategy individually are associated with improved outcomes, concerns persist regarding the safety and efficacy of combining these 2 techniques. We compared in-hospital and midterm outcomes for off-pump multivessel sequential and conventional coronary artery bypass grafting.Methods: From September 1998 to September 2008, 689 consecutive patients received off-pump multivessel sequential coronary artery bypass grafting performed by a single surgeon. These patients were propensity matched to 689 patients who underwent off-pump coronary artery bypass grafting without sequential anastomoses. A retrospective analysis of prospectively collected perioperative data was performed. In addition, medical notes and charts of all the study patients were reviewed. The mean duration of follow-up was 5.1 � 2.0 years.Results: The major in-hospital clinical outcomes in the sequential and control groups were found to be similar. After adjusting for clinical covariates, sequential grafting was not an independent predictor of in-hospital adverse events (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.86-1.50; P = .31), medium-term mortality (hazard ratio [HR], 1.26; 95% CI, 1.06-1.32; P = .92), and readmission to hospital (HR, 1.12; 95% CI, 0.96-1.20; P = .80). Sequential grafting was an independent predictor of receiving more than 3 distal anastomoses (OR, 7.46; 95% CI, 4.27-11.45; P < .0001). Risk-adjusted survival was 89% for sequential grafting patients and 88% for conventional grafting patients (P = .96) during the medium-term follow-up.Conclusion: Our analysis confirms the short- and midterm safety and efficacy of off-pump sequential coronary artery bypass grafting.

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