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. 2014 Jan;29(1):69-75.
doi: 10.3346/jkms.2014.29.1.69. Epub 2013 Dec 26.

Outcomes of off-pump coronary bypass grafting with the bilateral internal thoracic artery for left ventricular dysfunction

Suryeun Chung  1 , Wook Sung Kim  1 , Dong Seop Jeong  1 , Jaejin Lee  2 , Young Tak Lee  1
Affiliations

Outcomes of off-pump coronary bypass grafting with the bilateral internal thoracic artery for left ventricular dysfunction

Suryeun Chung et al. J Korean Med Sci. 2014 Jan.

Abstract

This study evaluated the outcomes of off-pump coronary artery bypass surgery (OPCAB) with severe left ventricular dysfunction using composite bilateral internal thoracic artery grafting. From January 2001 to December 2008, 1,842 patients underwent primary isolated OPCAB with composite bilateral internal thoracic artery grafting. A total of 131 of these patients were diagnosed with a severely depressed preoperative left ventricle ejection fraction (LVEF) (≤ 0.35). These patient outcomes were compared with the outcomes of 830 patients that had mildly or moderately depressed LVEF (0.36 to 0.59) and 881 patients with normal LVEF (>0.6). The early mortality for patients with severe LVEF was 2.3%. The 3-yr and 7-yr survival rate for patients with severe LV dysfunction was 86.0% and 82.8%, respectively. Multivariate analysis showed that severe LV dysfunction EF increased the risk of all-cause death (P=0.012; hazard ratio [HR],2.14; 95% confidence interval [CI],1.19-3.88) and the risk of cardiac-related death (P=0.008; HR,3.38; 95% CI, 1.37-8.341). The study identified positive surgical outcomes of OPCAB, although severe LVEF was associated with two-fold increase in mortality risk compared with patients who had normal LVEF.

Keywords: Coronary Artery Bypass, Off-Pump; Internal Mammary Artery; Ventricular Dysfunction.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
A photograph of the operative field showing the exposure aided by a stabilizing device and the internal thoracic artery composite grafts after completion of all anastomosis (20).
Fig. 2
Fig. 2
Different strategies for grafting the right coronary artery or its branches: (A) with the right internal thoracic artery as a part of the Y-composite graft (n = 666), (B) with the in situ right gastroepiploic artery (n = 418), (C) with a saphenous vein aorto-coronary graft (n = 286).
Fig. 3
Fig. 3
Survival curves according to left ventricular function: (A) overall survival, (B) survival free from cardiac death, (C) survival free from cardiac events.
See this image and copyright information in PMC

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