Coronary artery bypass grafting in patients with low ejection fraction: The effect of intra-aortic balloon pump insertion on early outcome

Background: Patients with low ejection fraction (EF) are at a higher risk for postoperative complications and mortality. Our objective was to assess the effect of low EF (<40%) on early clinical outcomes after coronary artery bypass grafting (CABG) and to determine the predictors of mortality. Methods: From June 2017 to February 2019, 170 consecutive patients underwent CABG. There were 120 patients with low EF (<40%; 37.49 ± 2.89%); 94 were men (78.3%), and the mean age was 55.83 ± 8.04 years. Fifty patients had normal EF (> 40; 57.90 ± 2.27 %), 41 were men (82.0%), and the mean age was 54.30 ± 7.01 years and used as a control group. Results: Overall 30-day mortality was 10/120 patients (8.3%). Factors associated with higher mortality were females ( 70.0% vs. 17.3%, P<0.001); older age (61.40 ± 7.01 vs. 55.32 ± 7.97 years, P=0.025); diabetes mellitus (100% vs. 51.8%; P=0.003); longer cardiopulmonary bypass time (148.70 ± 40.12 vs. 108.49 ± 36.89 min; P=0.012); longer cross clamp time (88.19 ± 31.94 vs.64.77 ± 22.67 min; P=0.049), longer total operative time (6.82 ± 1.03 vs 5.38 ± 0.95 hours; P=0.001); intra-aortic balloon pump (IABP) insertion (90.0% vs. 10.9%; P<0.001); intra-operative complications (60% vs. 1.8%, P<0.001); ventricular tachycardia and ventricular fibrillation (30% and 50% vs. 4.5% and 5.5% respectively; P=0.002 for both); myocardial infarction (70% vs 11.8%, P<0.001), and lower postoperative ejection fraction (21.46 ± 1.93 vs 40.30 ± 8.19 %, P<0.001). In patients with low EF, postoperative NYHA and CCS angina class have improved compared to the preoperative levels (1.50 ± 0.61 vs. 3.31 ± 0.56; p< 0.001 and 1.38 ± 0.52 vs. 3.11 ± 0.55; p< 0.001 respectively) Conclusion: Patients with low EF have a higher risk of morbidity and mortality; however, the clinical and echocardiographic parameters improve over time. Therefore, CABG remains a viable option in selected patients with low EF. Factors affecting our 30-days mortality were related to the severity of the disease.

Download Full-text

Outcome of Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting: Renal Function and Mortality After 3.8 Years

Circulation ◽

10.1161/circulationaha.105.000661 ◽

2006 ◽

Vol 114 (1_suppl) ◽

pp. I-414-I-419 ◽

Cited By ~ 28

Author(s):

G. S. Hillis

Keyword(s):

Renal Function ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Ejection Fraction ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Low Ejection Fraction

Download Full-text

Commentary: Coronary artery bypass grafting in midrange ejection fraction: Charting unknown waters

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2021.01.079 ◽

2021 ◽

Author(s):

Nicolas H. Pope ◽

Arman Kilic

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Ejection Fraction ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting

Download Full-text

Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000242 ◽

2016 ◽

Vol 11 (2) ◽

pp. 123-127 ◽

Cited By ~ 1

Author(s):

Kamales Kumar Saha ◽

Ajay Kumar ◽

Mandar Manohar Deval ◽

Kakalee K. Saha ◽

Rinu V. Jacob ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Bypass Surgery ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Off Pump ◽

Intra Aortic Balloon Pump ◽

Pump Coronary Artery Bypass

Objective Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion. Methods Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion). Results A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206). Conclusions Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.

Download Full-text