Myocardial Revascularization in Patients with Reduced Ejection Fraction
Journal Title: PARIPEX-Indian Journal of Research - Year 2016, Vol 5, Issue 7
Abstract
Background : Many studies have shown that a left ventricular ejection fraction (LVEF) ≤35% is associated with a reduced long term survival in patients on medical therapy and increased early mortality in those undergoing coronary artery bypass grafting (CABG).This study aims to investigate the short term outcome of patients with LVEF < 40% undergoing on or off pump CABG. Material and Methods:604 patients undergoing surgical myocardial revascularization (342 on pump and 262 off pump) between January 2014 – December 2015, in the Department of Cardiovascular Surgery of “Niculae Stancioiu” Heart Institute, were retrospectively analised. Of these, 76 (34 on pump and 42 off pump)had an LVEF <40% at admission and were considered suitable for the study. indication, type of surgery and short term outcome were retrospectively analysed. Patients with combined procedures (CABG +valvel surgery/LV aneurysmectomy) were excluded. Results:Myocardial revascularization was performed for stable angina in 18 patients and unstable angina in 58 cases.Subjects undergoing on pump CABG required more often inotropic support (15 vs 6, p = 0,0001) and longer periods of mechanical ventilation (15.2h vs 9.3h, p = 0,038). Perioperative hemorhage was more important (936 vs 725 ml, p = 0,01) and metabolic acidosis more frequent (11 vs 5, p = 0,001) in these cases. Moreover, they had longer hospital stay (9,2 vs 7,6, p = 0,001). Short term mortality in patients with LVEF <40% was 5.8% in those undergoing on pump CABG and 2.3% in those with off pump surgery.Conclusion:The results have shown that off pump CABG it’s safe and effective even in patients with impaired ejection fraction, with fewer adverse events and reduced mortality compared to the on pump strategy.
Authors and Affiliations
Adrian Molnar MD, Mada Olimpiu Razvan
Keywords
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