Myocardial revascularization using on-pump beating heart among patients with left ventricular dysfunction

Ahmad K Darwazah,Khalil Helwa,Ismail Isleem,Vivian Bader

doi:10.1186/1749-8090-5-109

Abstract

ObjectivesOn-pump beating heart technique for myocardial revascularization has been used successfully among both low and high risk patients. Its application among low ejection fraction patients is limited. The aim of our study is to evaluate this technique among patients with low ejection fraction and to compare results with off-pump bypass technique.MethodsThis retrospective study includes 137 patients with ejection fraction below 0.35 who underwent isolated coronary artery bypass surgery. 39 patients underwent myocardial revascularization using on-pump beating heart (ONCAB/BH), while 98 patients had off-pump beating heart (OPCAB). Different preoperative, operative and postoperative variables were evaluated among both groups.ResultsPatients profiles and risk factors were similar among both groups, except for the number of patients undergoing redo CABG which was significantly higher among ONCAB/BH (13% vs 3%; p = 0.025). Ejection fraction (EF) varied from 10-34%. The mean EF for patients who underwent ONCAB/BH was 28 ± 6 in comparison to 26 ± 5 for OPCAB patients (P = 0.093). Predicted risk for surgery according to EuroSCORE was similar among both groups (P = 0.443). The number of grafts performed per patient was significantly more among patients who underwent ONCAB/BH (2.2 ± 0.7 Vs 1.7 ± 0.7; P = 0.002). Completeness of revascularization was significantly greater in the ONCAB/BH patients (72% Vs 46%, P = 0.015). The incidence of hospital mortality and combined major morbidity was more among ONCAB/BH in comparison to OPCAB, but the difference was not significant. However, the incidence of blood loss, ventricular arrythmias, inotropic support, ICU, hospital stay and blood transfusion were significantly greater among patients who underwent ONCAB/BH.ConclusionsOn-pump beating heart technique can be used in myocardial revascularization among patients with left ventricular dysfunction. The technique was found to be associated with better myocardial revascularization when compared with OPCAB technique. However, the incidence of morbidity and mortality was more than OPCAB.

Highlights

Despite the presence of different pump techniques used in surgical myocardial revascularization, the optimal method used is still controversial
There was no differences among both groups, except for the number of patients undergoing redo CABG, which was significantly higher among ONCAB/ BH (13% Vs 3%, P = 0.025)
The incidence of main stem involvement was more among ONCAB/BH patients, but the difference did not reach statistical significance (8% Vs 4%, P = 0.765)

Summary

Introduction

Despite the presence of different pump techniques used in surgical myocardial revascularization, the optimal method used is still controversial. Nowadays we are confronted with different categories of patients varying from straightforward low risk cases to complicated ones due to the increase in number of elderly patients. The use of both conventional cardiopulmonary bypass and OPCAB among patients with impaired LVF proved its efficiency and safety [1,2]. ONCAB/BH technique was used to revascularize the myocardium among patients with impaired LVF. The results of such technique was compared to those who underwent off-pump beating heart

Objectives

Methods

Results