Early And Long-term Comparison Of The On- And Off-pump Bypass Surgery In Patients With Left Ventricular Dysfunction

Objective: To compare the early and long-term outcomes after off-pump coronary artery bypass grafting(OPCAB)and on-pump coronary artery bypass grafting(ONCAB)in patients with left ventricular dysfunction(LVD).Methods: Between January 2006 and January 2016,2,132 patients underwent isolated coronary artery bypass grafting in our hospital and 222 patients with LVD [Left ventricular ejection fraction(LVEF)≤ 50%)were investigated retrospectively.The OPCAB group contained 145 patients and the ONCAB group contained 77 patients.Age,Euro SCORE-Ⅱ and preoperative echocardiography parameters(LVEF;left ventricular end-diastolic dimension,LVEDD)were compared and 73 patients in each group were matched.Perioperative and 1-year postoperative echocardiography were performed to evaluate the changes of left ventficular geometry and function.Early and long-term outcomes were compared between matched groups.Kaplan-Meier curves were generated,and a log-rank test was used for comparison between the 2 groups.Risk factors were investigated for long-term survival of the patients by log-rank test and multivariable Cox regression models.Results: In-hospital mortality was higher in ONCAB compared to OPCAB(8.2% vs 2.7%),but this difference did not reach statistical significance(P=0.275).Compared with ONCAB,OPCAB was associated with significantly lower incidences of prolonged ventilation(4 vs 15,P=0.007),prolonged intensive care unit admission(11 vs 32,P<0.001),utilization of intra-aortic balloon pump(3 vs 10,P<0.05),low cardiac output syndrome(1 vs 8,P<0.05)and major adverse cardiac and cerebral event(MACCE)(2 vs 9,P=0.028).The mean LVEF was improved significantly in both groups.However,the degree of improvement of LVEF in OPCAB group was significantly higher than that in ONCAB group(P=0.022).The mean follow-up time was 5.86±2.47 years,and 10 patients were lost during the follow-up.The overall 10-year actuarial survival rates of the OPCAB and On-pump CABG group were 82.4% vs 69.8%(P>0.05),and there were no significant differences in 10-year rates of freedom from MACCE(P>0.05).Multivariate analysis revealed that age more than 70 years and Euro SCORE-Ⅱ>5% were independent predictor of long-term deaths.Conclusions: Myocardial function of patients with LVD was improved in both groups.OPCAB is associated with significantly reduced early morbidity in patients with an LVEF of less than 50%.Off-pump and On-pump surgical revascularization resulted in equivalent long-term outcomes.