Organ Dysfunction in Patients with Left Ventricular Impairment: What is the Effect of Cardiopulmonary Bypass?

Abstract

We have previously demonstrated that avoidance of cardiopulmonary bypass may reduce early mortality and cardiac related complications in patients with left ventricular dysfunction. This study examines the impact of cardiopulmonary bypass in the same subgroup in terms of organ dysfunction and non-cardiac related complications A systematic literature review identified 24 studies including 7,976 patients. Data was extracted for the following outcomes of interest: stroke, renal failure, ventilation time, pulmonary complications and sternal wound infection. Random effects meta-analysis was used to aggregate the data. Sensitivity and heterogeneity were assessed. Meta-analysis through subgroup analysis of the highest quality studies revealed that the off-pump technique is associated with significantly lower incidence of stroke, renal failure, ventilation time and sternal wound infection. These results highlight an important link between cardiopulmonary bypass and the incidence of multi-organ dysfunction in patients with left ventricular dysfunction. The results add to the growing body of evidence that off-pump surgery is more beneficial in high-risk patients. Even in the light of mixed reports on graft patency and completeness of revascularisation, the technique may be justified in selected patients in attempt to reduce organ dysfunction.