Mid-term Outcomes of Isolated Coronary Artery Bypass Grafting with Reduced Left Ventricular Function

Hiroki Hata, Koichi Toda, Shigeru Miyagawa, Yasushi Yoshikawa, Shunsuke Saito, Keitaro Domae, Ryohei Matsuura, Shin Yajima, Yoshiki Sawa

Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–B

Abstract

Objective: Surgical outcomes of coronary artery bypass grafting (CABG) for patients with reduced left ventricular (LV) function have not been well described. We assessed the mid-term outcomes of CABG for patients with low ejection fraction (EF) including the impact of off-pump CABG (OPCAB) and bilateral internal thoracic artery (BITA) usage.

Methods: Consecutive 965 patients who underwent isolated CABG between 2002 and 2016, were enrolled. Of these, 164 patients (17.0%) were with reduced left ventricular function (LVEF <40%) (Group lwEF) and the other 801 patients were with preserved LV function (LVEF≧40%) (Group pvEF). The operation was performed via median sternotomy (98.2%) or small left thoracotomy either on- (21.2%) or off-pump.

Results: Mean follow-up period was 3.8 years. Mean age was 69.3 vs 68.3 years (Group pvEF vs Group lwEF) and mean LVEF was 61.5% vs 32.6%. Male patients and patients having history of myocardial infarction and/or percutaneous coronary intervention were significantly more prevalent in Group lwEF. Mean number of graft anastomoses was 3.1 vs 3.3 (p=0.049). The rates of OPCAB, BITA usage, and all arterial grafting in both groups were 86.0% vs 43.3%, 55.0% vs 41.3%, and 42.3% vs 28.7% (p<0.01, each), respectively. The overall survival and freedom from MACCE were significantly better in Group pvEF than Group lwEF (91.3% vs 78.4% and 69.9% vs 57.6% at 5 years, p<0.01, respectively). In Group lwEF, small preoperative LV end-systolic volume was independent predictor of significant EF improvement. Although the usage of BITA as well as OPCAB positively affected long-term survival in Group pvEF, no significant difference was observed in Group lwEF.

Conclusions: The surgical outcomes of CABG in patients with reduced LVEF were significantly worse than patients with preserved LVEF. BITA use and OPCAB did not provide favorable impact in patients with reduced LVEF.