Is low ejection fraction safe for off-pump coronary bypass operation?

Background. Does the manipulation of the heart during off-pump coronary art ery bypass (OPCAB) procedure further compromise the hemodynamic stability o f a patient with depressed left ventricular function compared with the conv entional coronary artery bypass (CCAB) approach? Does this manipulation ind uce a more dramatic hypoperfused state that may contribute to an increase i n the incidence of related complications or mortality? This retrospective r eview of data attempted to answer the above concern. Methods. Between January 1, 1998, and June 30, 1999, 177 patients with ejec tion fractions of 30% or less underwent full sternotomy coronary artery byp ass grafting at our institution. Of these patients, 45 underwent OPCAB proc edures and 132 patients underwent CCAB. Pre-, intra-, and postoperative var iables as identified by The Society of Thoracic Surgeons National Cardiac S urgery Database were compared using univariate and logistical regression an alysis. Results. Despite recognized hemodynamic derangement during cardiac displace ment, these groups of OPCAB patients appeared to tolerate the procedure wel l. Univariate analysis of cardiac enzyme leak and blood loss was statistica lly significant in the OPCAB patients. Utilizing regression analysis, cardi opulmonary bypass was the only predictor for all postoperative complication s. Conclusions. Multivessel coronary artery bypass utilizing the OPCAB approac h in patients with depressed left ventricular function of equal to or less than 30% is appropriate and applicable. Analysis of CCAB and OPCAB variable s was nonsignificant except for operative and postoperative blood loss and peak cardiac enzyme leak. Attention to intraoperative detail and hemodynami c management could be credited for the success with OPCAB. (Ann Thorac Surg 2000;70:1021-5) (C) 2000 by The Society of Thoracic Surgeons.