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Off-Pump Revascularization for Significant Left Ventricular Dysfunction

Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA

For reprint information contact: Y Joseph Woo, MD Tel: 1 215 662 2956 Fax: 1 215 349 5798 Email: wooy{at}uphs.upenn.edu, Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, 6 Silverstein Pavilion 3400 Spruce St., Philadelphia, PA 19104, USA.

Left ventricular dysfunction is a predictor of perioperative morbidity and mortality in on-pump coronary artery bypass grafting. Obligatory global myocardial ischemia and injury induced during crossclamping as well as adverse systemic effects of cardiopulmonary bypass may induce a disproportionately greater overall physiologic insult in patients with poor ventricular function. All patients undergoing nonemergency off-pump coronary artery bypass by a single surgeon during an 18-month period were retrospectively analyzed. Two groups with preoperative ejection fraction classified as poor (10%–35%; n = 31) or normal (55%–80%; n = 60) were compared. The mean ejection fractions were 26% ± 1% and 63% ± 1% respectively, p < 0.000001. In those with significant left ventricular dysfunction, there were 2.8 ± 0.1 grafts per patient, time to extubation was 8.4 ± 1.2 hours, and discharge was after 4.9 ± 0.6 days. These results were statistically equivalent to those in the group with normal left ventricular function. There was no intraaortic balloon pump insertion or mortality in either group. This technique provides an effective means of safely revascularizing patients with significant left ventricular dysfunction, and it may provide a valuable alternative approach in patients with ischemic cardiomyopathy.