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Early and midterm outcome after off-pump coronary artery bypass grafting in patients with left ventricular dysfunction.
Heart Surg Forum. 2004; 7(6):E539-45; discussion E539-45.HS

Abstract

BACKGROUND

The purpose of this study was to define the early outcome and the potential for midterm survival in patients with left ventricular dysfunction (LVD) who undergo off-pump coronary artery bypass (OPCAB) and to compare these results with those of conventional coronary artery bypass grafting (CABG).

METHODS

Medical records of patients with LVD (n = 732) between January 1998 and March 2002 were retrospectively reviewed. There were 523 patients with moderate LVD (ejection fraction, 30%-50%; 463 CABG versus 60 OPCAB) and 209 patients with severe LVD (ejection fraction, < 30%; 136 CABG versus 73 OPCAB). Midterm survival data (mean follow-up, 2.3 years) were obtained from the National Death Index. Groups were compared by multivariate Cox proportional hazard models, and Kaplan-Meier curves were plotted.

RESULTS

CABG patients had lower European System for Cardiac Operative Risk Evaluation values (5.3 versus 7.2 and 8.0 versus 9.6 in moderate and severe LVD subgroups, respectively; P < .001). There were no differences (OPCAB versus CABG) in 30-day mortality (3.3% versus 1.9%, moderate LVD group, P = .366; 6.8% versus 4.4%, severe LVD group, P = .521), length of stay (9.3 versus 8.6 days, moderate LVD group, P = .683; 11.9 versus 11.8 days, severe LVD group, P = .423), and postoperative complications (13.3% versus 11.0%, moderate LVD group, P = 0.663; 16.4% versus 20.6%, severe LVD group, P = .581). Successful coronary bypass in patients with severe LVD was associated with 68.2% and 66.2% actuarial 48-month survival rates for the CABG and OPCAB patients, respectively (P = .336), and these rates rose to 86.0% and 82.9% in patients with moderate LVD (P = .121). When CABG patients with moderate LVD were considered the reference group, the adjusted hazard ratio of OPCAB patients with moderate LVD for midterm mortality was 1.32 (95% confidence interval, 0.61-2.87; P = .481). CABG and OPCAB patients with severe LVD had the same adjusted hazard ratio of 1.86, and this figure was statistically significant compared with the value for the reference group (P = .011 and P = .039, respectively).

CONCLUSIONS

Patients with LVD can derive midterm benefit from coronary bypass. OPCAB in higher-risk patients had early and midterm outcomes similar to those of CABG.

Authors+Show Affiliations

Department of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, New York, New York 10128, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

15769682

Citation

Toumpoulis, Ioannis K., et al. "Early and Midterm Outcome After Off-pump Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction." The Heart Surgery Forum, vol. 7, no. 6, 2004, pp. E539-45; discussion E539-45.
Toumpoulis IK, Anagnostopoulos CE, DeRose JJ, et al. Early and midterm outcome after off-pump coronary artery bypass grafting in patients with left ventricular dysfunction. Heart Surg Forum. 2004;7(6):E539-45; discussion E539-45.
Toumpoulis, I. K., Anagnostopoulos, C. E., DeRose, J. J., & Swistel, D. G. (2004). Early and midterm outcome after off-pump coronary artery bypass grafting in patients with left ventricular dysfunction. The Heart Surgery Forum, 7(6), E539-45; discussion E539-45.
Toumpoulis IK, et al. Early and Midterm Outcome After Off-pump Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction. Heart Surg Forum. 2004;7(6):E539-45; discussion E539-45. PubMed PMID: 15769682.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early and midterm outcome after off-pump coronary artery bypass grafting in patients with left ventricular dysfunction. AU - Toumpoulis,Ioannis K, AU - Anagnostopoulos,Constantine E, AU - DeRose,Joseph J, AU - Swistel,Daniel G, PY - 2005/3/17/pubmed PY - 2006/12/14/medline PY - 2005/3/17/entrez SP - E539-45; discussion E539-45 JF - The heart surgery forum JO - Heart Surg Forum VL - 7 IS - 6 N2 - BACKGROUND: The purpose of this study was to define the early outcome and the potential for midterm survival in patients with left ventricular dysfunction (LVD) who undergo off-pump coronary artery bypass (OPCAB) and to compare these results with those of conventional coronary artery bypass grafting (CABG). METHODS: Medical records of patients with LVD (n = 732) between January 1998 and March 2002 were retrospectively reviewed. There were 523 patients with moderate LVD (ejection fraction, 30%-50%; 463 CABG versus 60 OPCAB) and 209 patients with severe LVD (ejection fraction, < 30%; 136 CABG versus 73 OPCAB). Midterm survival data (mean follow-up, 2.3 years) were obtained from the National Death Index. Groups were compared by multivariate Cox proportional hazard models, and Kaplan-Meier curves were plotted. RESULTS: CABG patients had lower European System for Cardiac Operative Risk Evaluation values (5.3 versus 7.2 and 8.0 versus 9.6 in moderate and severe LVD subgroups, respectively; P < .001). There were no differences (OPCAB versus CABG) in 30-day mortality (3.3% versus 1.9%, moderate LVD group, P = .366; 6.8% versus 4.4%, severe LVD group, P = .521), length of stay (9.3 versus 8.6 days, moderate LVD group, P = .683; 11.9 versus 11.8 days, severe LVD group, P = .423), and postoperative complications (13.3% versus 11.0%, moderate LVD group, P = 0.663; 16.4% versus 20.6%, severe LVD group, P = .581). Successful coronary bypass in patients with severe LVD was associated with 68.2% and 66.2% actuarial 48-month survival rates for the CABG and OPCAB patients, respectively (P = .336), and these rates rose to 86.0% and 82.9% in patients with moderate LVD (P = .121). When CABG patients with moderate LVD were considered the reference group, the adjusted hazard ratio of OPCAB patients with moderate LVD for midterm mortality was 1.32 (95% confidence interval, 0.61-2.87; P = .481). CABG and OPCAB patients with severe LVD had the same adjusted hazard ratio of 1.86, and this figure was statistically significant compared with the value for the reference group (P = .011 and P = .039, respectively). CONCLUSIONS: Patients with LVD can derive midterm benefit from coronary bypass. OPCAB in higher-risk patients had early and midterm outcomes similar to those of CABG. SN - 1522-6662 UR - https://www.unboundmedicine.com/medline/citation/15769682/Early_and_midterm_outcome_after_off_pump_coronary_artery_bypass_grafting_in_patients_with_left_ventricular_dysfunction_ DB - PRIME DP - Unbound Medicine ER -