Patients with Left Ventricular (LV) Dysfunction: Is OPCAB Advantageous over Conventional CABG in our settings?

Abstract

Objective: Off-pump CABG (OPCAB) is a well established surgical procedure in Bangladesh now. Majority of Bangladeshi patients having CABG are undergoing OPCAB procedures these days. Patients with left ventricular dysfunction are known to be particularly at risk of complications after surgical coronary revascularization. Off-pump procedure can be considered in these patients, avoiding the potentially damaging effect of cardiopulmonary bypass (CPB). Patients with left ventricular dysfunction are thus thought to be ideal OPCAB candidates. This study is undertaken to check the advantage of OPCAB over conventional CABG of Bangladeshi patients with left ventricular dysfunction.

Methods: This is a prospective clinical trial done in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of January 2006 to Dec 2007. Among the 52 patients 26 patients underwent OPCAB with preoperative ejection fraction (EF) 35.2±3.2% and rest 26 patients had conventional bypass (CCABG) with preoperative EF 33.4±3.8%. Different variables were evaluated and compared. Echocardiography was used both pre and postoperatively to assess the LVEF, LVIDd and LVIDs and regional wall motion abnormality and to assess the presence or absence of ischemia or infarction. Data were collected by interview schedule and checklist. Data were analyzed by standard statistical methods.

Results: In this small series of patients with left ventricular dysfunction, off-pump CABG was carried out with good early outcome; with low mortality and morbidity and significant improvement in postoperative left ventricular function. There was no significant difference between the groups in terms of change in EF, LVIDd and LVIDs.

Conclusion: From this study it can be concluded that both the surgical strategies improved the myocardial function and early outcome in patients with left ventricular dysfunction. However OPCAB surgery has a somewhat better result regarding ventilation time and ICU stay. Thus both OPCAB and on pump surgery can be performed safely and effectively in patients with left ventricular dysfunction with good results and low mortality.

Keywords: Left ventricular function; CABG; OPCAB

DOI: http://dx.doi.org/10.3329/cardio.v3i2.9181

Cardiovasc. J. 2011; 3(2): 131-135