DOI: http://dx.doi.org/10.18203/2349-2902.isj20172011

A comparison of clinical outcomes of LVEF ≤35% versus LVEF>35% in off-pump coronary artery bypass graft surgery

Manju Gupta, Pankaj Kumar Mishra, Mohd Shoeb, Amit Agarwal, Jagdish Prasad

Abstract


Background: Management of patients with coronary artery disease (CAD) and low ejection fraction (EF) is challenging. The objective was to compare the effect of low EF to normal EF on clinical outcomes after off-pump coronary artery bypass graft (OPCABG) surgery.

Methods: All patients who underwent CABG at VMMC and Safdarjung hospital, from June 2014 till December 2016 with LVEF≤35% (low EF) as well as LVEF>35% (high EF) were studied and their surgical results analyzed by collecting data retrospectively. Out of 203 total patients the LVEF was less than or equal to 35% in 41 (20.19 %) patients, more than 35% in162 (79.81 %) patients.

Results: In LVEF≤35% there were 9 females and the mean age was 60.39±8.76 years, The mean ICU stay in hospital was of 8.73 days, mean ventilator support was 4.01 days, ionotropic support was 4.34 days, mean stay in hospital was of 28.54 days, hospital mortality was 8 (19.51%) in LVEF≤35 versus mean ICU stay in hospital was of 8.73 days, ventilator support was 4.01 days, ionotropic support 4.34 days, mean stay in hospital was of 20.33 days, hospital mortality was 13 (8.02%) in LVEF>35.These data make a survival rate of 80.49% for EF in LVEF≤35 versus 91.98% for EF in LVEF>35.

Conclusions: CABG can be safely performed in low-EF patients with minimal postoperative morbidity and mortality in addition to encouraging home discharge rates.


Keywords


Comparison, Off pump CABG, Outcome, LVEF≤35 versus LVEF>35

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References


John R, Rajasinghe HA, Chen JM, Weinberg AD, Sinha P, Mancini DM, et al. Long-term outcomes after cardiac transplantation: an experience based on different eras of immunosuppressive therapy. Ann Thorac Surg. 2001;72:440-9.

Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, et al. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983;68:785-95.

Scott SM, Deupree HL, Sharma GVRK, Luchi RJ. VA study of unstable angina. 11-year results show duration of surgical advantage for patients with impaired ejection fraction. Circulation. 1994;90(suppl II):120-3.

Zubiate P, Kay JH, Mendez AM. Myocardial revascularization for the patient with drastic impairment of function of the left ventricle. J Thorac Cardiovasc Surg. 1977;73:84-6.

Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, et al. Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions. J Thorac Cardiovasc Surg. 1998;116:997-1004.

Passamani E, Davis KB, Gillespie MJ, Killip T. A randomized trial of coronary artery bypass surgery. Survival of patients with a low ejection fraction. N Engl J Med. 1985;312:1665-71.

Milano CA, White WD, Smith LR. Coronary artery bypass grafting in patients with severely depressed ventricular function. Ann Thorac Surg. 1993;56:483-93.

Christakis GT, Weisel RD, Fremes SE. Coronary artery bypass grafting in patients with poor ventricular function. J Thorac Cardiovasc Surg. 1992;103:1083-92.

Zubiate P, Kay JH, Mendez AM. Myocardial revascularization for the patients with drastic impairment of function of the left ventricle. J Thorac Cardiovasc Surg. 1977;73:84-6.

Puskas JD, Edwards FH, Pappas PA, O’Brien S, Peterson ED, Kilgo P, et al. Off-pump techniques benefit men and women and narrow the disparity in mortality after coronary bypass grafting. Ann Thorac Surg. 2007;84:14.

Tabata M, Takanashi S, Fukui T, Horai T, Uchimuro T, Kitabayashi K, et al. Off-pump coronary artery bypass grafting in patients with low eject fraction. Ann Thorac Surg. 2002;17:383-5.

Luciani GB, Faggian G, Razzolini R, Livi U, Bortolotti U, Mazzucco A. Severe ischemic left ventricular failure: coronary operation or heart transplantation? Ann Thorac Surg. 1993;55:719-23.

Oz MC, Kherani AR, Rowe A, Roels L, Crandall C, Tomatis L, et al. How to improve organ donation: results of the ISHLT/FACT poll. J Heart Lung Transplant. 2003;22:389-410.

Hata M, Raman JS, Storer M, Matalanis G, Rosalion A, Buxton BF, et al. The mid-term outcome of geometric endoventricular repair for the patients with ischemic left ventricular dysfunction. Ann Thorac Cardiovasc Surg. 2003;9:241-4.

Oz MC, Konertz WF, Raman J, Kleber FX. Reverse remodelling of the failing ventricle: surgical intervention with the Acorn Cardiac Support Device. Congest Heart Fail. 2004;10:96-105.

Bouchart F, Tabley A, Litzler PY, Haas-Hubscher C, Bessou JP, Soyer R. Myocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long term follow-up in 141 patients. Eur J Cardiothorac Surg. 2001;20:1157-62.

Carr JA, Haithcock BE, Paone G, Bernabei AF, Silverman NA. Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction. Ann Thorac Surg. 2002;74: 1531-6.

Islamoglu F, Apaydin AZ, Posacioglu H, Ozbaran M, Hamulu A, Buket S, et al. Coronary artery bypass grafting in patients with poor left ventricular function. Jpn Heart J. 2002;43:343-56.

Hausmann H, Topp H, Siniawski H, Holz S, Hetzer R. Decision-making in end-stage coronary artery disease: revascularization or heart transplantation? Ann Thorac Surg. 1997;64:1296-302.