Off-pump CABG “an effective option” for patients with reduced ejection fraction

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Off-pump coronary artery bypass grafting (OPCABG) is a safe and effective option for the treatment of patients with reduced ejection fraction (EF). That is according to the findings of a study published in the Journal of Cardiac Surgery comparing the efficacy and mid-term outcomes of OPCABG to conventional, on-pump CABG surgery for patients with reduced EF.

Authored by Anneke Neumann (Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany and Department of Vascular and Endovascular Surgery, Hospital Ludwigsburg, Ludwigsburg, Germany) et al, the study sought to compare in‐hospital outcomes and early survival rates of ONCAB‐ and OPCAB‐surgery in patients with low ejection fraction, with a focus on the completeness of revascularisation.

Neumann and colleagues note that the use of cardiopulmonary bypass (CPB) has been seen as the gold standard for surgical coronary revascularisation, and “has led to excellent results with low mortality rates and associated complications”. During CPB, the patient’s blood is continuously exposed to the foreign surface of the heart‐lung machine, they detail, thus eliciting a number of inflammatory reactions, which are known to contribute to the morbidity and mortality of CABG.

OPCABG is a method to achieve surgical coronary revascularisation without the use of CPB, thus avoiding its negative effects, they explain.

The study team performed a retrospective review of patient demographics, preoperative risk factors, operative and postoperative outcomes of patients with left ventricular EF (LV‐EF) ≤35%, who underwent CABG at University Medical Center Tübingen between January 2015 and December 2017. Propensity score and multivariate logistic regression analysis were used to compare risk adjusted outcomes between groups.

Overall, 111 consecutive CABG‐patients with LV‐EF ≤35% underwent either ONCAB (46 patients, 41.4%) or OPCAB surgery (65 patients, 58.6%). The study team reports that there was no difference in early mortality (5% vs. 7.5%, p=0.64) between the two groups.

After propensity score matching, OPCAB‐patients required significantly less resternotomies for bleeding (20% vs. 2.5%, p=0.03) and consequently received fewer blood transfusions (57.5% vs. 32.5%, p=0.03). Fewer OPCAB‐patients experienced low cardiac output syndrome (22.5% vs. 42.5%, p=0.06) and suffered from postoperative delirium (22.5% vs. 42.5%, p = .06) Neumann and colleagues report.

Additionally, there were no differences in completeness of revascularisation between the two groups (median 1 (1.0–1.33; 1.0–1.33) OPCAB versus median 1 (1–1.33; 0.67–2) ONCAB, p=0.95). Survival after six months, one year and three years was similar for ONCAB‐ and OPCAB‐patients (ONCAB 92.3%, 89.4%, and 89.4% vs. OPCAB 89.8%, 85.7%, and 82.1%; p=0.403). More ONCAB‐patients needed a coronary reintervention during follow‐up (8.6% vs. 2.3%, p=0.402).

These results led Neumann and colleagues to conclude OPCAB‐surgery is a safe and effective option for patients with reduced EF. “Furthermore,” they state, “it does not come at the expense of less complete revascularisation or increased coronary re‐intervention during early follow‐up”.


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