Patients presenting with severe left ventricular (LV) dysfunction who undergoing coronary artery surgery are at increased risk of perioperative morbidity and mortality. This study compares early and short-term outcomes after on-pump beating-heart coronary artery bypass grafting (CABG) versus conventional CABG in patients with ejection fraction (EF) less than 30%.
287 patients with ejection fraction less than 30% underwent CABG from July 2005 to July 2009 were analyzed, On-pump beating-heart CABG was done in 137 patients (group 1) and 150 patients were done using conventional technique (group2( .
In-hospital mortality was less in the on-pump beating-heart CABG group (4.37% versus 4.66%). The total blood loss was less in group 1, but there was no difference statistically. Perioperative Intra-aortic balloon pump (IABP) was inserted in 23 patients, 16 patients in the conventional CABG group whereas only 7 patients required this in the on-pump beating-heart CABG group. The ventilation time was longer in conventional group it was 11.2±8.3 hours versus.8.2±7.7 in on pump beating group. No significant difference was found in morbidity including stroke and renal failure. The incidence of postoperative arrhythmia including atrial fibrillation was significantly less in on pump beating group as compared to conventional group it occurred in 10 patients versus 21 respectively. The duration of intensive care unit stay and the hospital stay were shorter in the on-pump beating-heart CABG group, it was significantly different. Short-term outcome revealed improvement in ejection fraction and clinical symptoms of the patients in both groups.
On-pump beating-heart CABG can be performed safely in high- risk patients with accepted morbidity and mortality rate. Short-term clinical outcome is encouraging and seems to justify surgical revascularization for this high-risk group of patients.