OFF-PUMP VERSUS ON-PUMP CORONARY ARTERY BYPASS GRAFTING IN SEVERE LEFT VENTRICULAR DYSFUNCTION

Abstract

The potential benefit of off-pump coronary artery bypass graft (OPCAB) in patients with severe left ventricular (LV) dysfunction is unknown. We performed a multi-center longitudinal analysis of OPCAB versus on-pump coronary artery bypass graft (ONCAB) in patients with LV ejection fraction (LVEF)≤35%. Between 10/2008 03/2016, 50,115 cases of primary isolated coronary artery bypass grafting (CABG) were performed in Ontario, Canada. Of 6034 patients (12%) with LVEF≤35%, 1116/6034 (18.5%) underwent OPCAB and 4918/6034 (81.5%) underwent ONCAB. Propensity score matching resulted in 1055 identical pairs. Mean and maximum follow-up were 4.1 and 8.5 years, respectively. Primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite endpoint of death, stroke, acute myocardial infarction (AMI), and repeat revascularization. OPCAB was associated with improved 30-day freedom from MACCE (HR 0.62[0.44- 0.87], p< 0.01), survival (HR 0.60[0.38-0.96], p=0.03) and AMI (HR 0.22[0.05-1.03], p=0.04). OPCAB was also associated with lower in-hospital stroke (<0.5% vs 1.8%, p 0.01), renal dysfunction requiring dialysis (0.9% vs 2.5%, p<0.01). At 8 years, there were no differences in freedom from MACCE (Figure 1) (HR 0.95[0.82-1.10], p=0.44), survival (HR 0.92[0.77-1.09], p=0.23), and re-hospitalization for heart failure (HR 1.08[0.90- 1.29], p=0.40). Total number bypass grafts for OPCAB vs ONCAB were similar (3.29±1.2 vs 3.31±1.0, p=0.61). OPCAB was associated with improved short-term MACCE in patients with LV dysfunction, but no difference in long term outcomes was observed. The total number of grafts were similar between groups.