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Shantanu Pande
Surendra K Agarwal
Anirban Kundu
Niraj Kale
Udgeath Dhir
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ORIGINAL ARTICLE

Off-Pump Coronary Artery Bypass in Severe Left Ventricular Dysfunction

Shantanu Pande, MCh, Surendra K Agarwal, MCh, Anirban Kundu, MCh, Niraj Kale, MCh, Amit Chaudhary, MS, Udgeath Dhir, MS

Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Shantanu Pande,, MCh, Tel: +91 5222668800, Extn 2212, Fax: +91 5222668017, Email: spande{at}sgpgi.ac.in, Department of Cardiovascular and Thoracic Surgery, Lucknow 226014, UP, India.

ABSTRACT

The outcome of multivessel off-pump coronary artery bypass grafting in cases of severe left ventricular dysfunction was studied in 58 consecutive patients with ejection fraction ≤35% who were followed up for a median of 15 months. Patients with ejection fractions ≤25% (group 1) had the largest left ventricular dimensions preoperatively, with gradual increases during follow-up; those with ejection fractions of 26%–35% (group 2) had smaller preoperative ventricular dimensions, with left ventricular regression postoperatively. There was more improvement in ejection fraction in group 2 than group 1 (33% vs. 10%). Mitral regurgitation improved from moderate to mild in group 2; whereas in group 1, mild mitral regurgitation progressed to moderate or severe during follow-up. Ejection fraction was a predictor of more frequent use of intraaortic balloon pumping, longer duration of inotropic use, a higher mean pulmonary artery-to-systemic arterial pressure ratio, and increased postoperative drainage.

Key Words: Coronary Artery Bypass • Off-Pump • Coronary Artery Disease • Mitral Valve Insufficiency • Left Ventricular Dysfunction

Asian Cardiovasc Thorac Ann 2009; 17:54-58
© 2009 by SAGE Publications
DOI: 10.1177/0218492309102540




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