J Korean Med Sci.  2014 Jan;29(1):69-75. 10.3346/jkms.2014.29.1.69.

Outcomes of Off-Pump Coronary Bypass Grafting with the Bilateral Internal Thoracic Artery for Left Ventricular Dysfunction

• Chung S
• Kim WS
• Jeong DS
• Lee J
• Lee YT

• KMID: 1796917
• DOI: http://doi.org/10.3346/jkms.2014.29.1.69

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) (< or =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.

Keyword

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

MeSH Terms

Coronary Artery Bypass, Off-Pump/methods/*mortality
Female
Heart
Humans
Male
Mammary Arteries/*transplantation
Middle Aged
Retrospective Studies
Stroke Volume
Survival Rate
Treatment Outcome
Vascular Grafting/methods/*mortality
Ventricular Dysfunction, Left/mortality/*surgery
Ventricular Function, Left

Figure

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  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).

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  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).

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  Fig. 3 Survival curves according to left ventricular function: (A) overall survival, (B) survival free from cardiac death, (C) survival free from cardiac events.

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