10-Year Outcomes following Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery in Patients with Severe Left Ventricular Dysfunction

Objectives: Severe left ventricular dysfunction (LVD) (ejection fraction <35%) has been associated with increased perioperative risk following coronary artery bypass graft surgery (CABG). Off-pump CABG (OPCAB) has shown to be beneficial in other high-risk patient cohorts. However, long-term outcomes in patients with severe LVD following OPCAB still remain unknown. The purpose of this study was to compare the early- and long-term outcomes of OPCAB and conventional CABG (ONCAB) in patients with severe LVD.

Methods: Retrospective single-center analysis including a total of 1,161 consecutive patients with severe LVD who underwent isolated CABG between 2002 and 2014. Among them, 442 underwent OPCAB and 719 underwent ONCAB. Primary outcomes were 30-day and long-term all-cause mortality.

Result: Patients' basal characteristics were similar in both groups. Incomplete revascularization rates were higher in the OPCAB group (21.7 vs. 35.2%; p < 0.01). Lower 30-day mortality was observed in OPCAB patients (7.1 vs. 4.3%; p = 0.05). Early complications were comparable in both groups. Mortality estimates were comparable for both OPCAB and ONCAB at 5 years (31 vs. 36%) and 10 years (54 vs. 57%), respectively (p = 0.13). COPD (OR: 1.52; p < 0.01) and incomplete revascularization (OR: 1.46; p <0.01) were identified as predictors of early mortality. Furthermore, COPD (HR: 1.40; p = 0.04), peripheral artery disease (HR: 1.24; p = 0.03), and diabetes mellitus (HR: 1.26; p = 0.01) were identified as predictors of long-term mortality.

Conclusion: OPCAB is safe and efficacious in patients with severe LVD. Short-term results after OPCAB show a trend toward lower mortality. Long-term mortality rates are similar among OPCAB and ONCAB patients. Survival benefits of complete revascularization are more evident among OPCAB patients.

Publication History

Article published online:
19 February 2021