CRONARY REVASCULARIZATION IN PATIENTS WITH LOW EJECTION FRACTION

Abstract

Introduction. As the operation of CABG on the beating heart become more and more used in many centers allover the world, we studied the difference between this technique and the classic CABG with on pump especially their effects on patients with low ejection fraction. Material and methods. Our study was prospective non-randomized. We studied 405 patients of them 60% (239 patients) with the on pump technique and 40% (166 patients) with the off pump technique. We compared between the results of 2 groups for all the patients and after dividing the patients into 2 subgroups; group A concerning patients with low ejection fraction (EF :S 50) and group B concerning patients with conserved ejection fraction (EF> 50). Postoperative follow up angiography was done for 51% of patients in the off pump group. Results. Statistical results gave us the following: All the preoperative risk factors were equal in the 2 groups. For the postoperative results, the on pump technique had less postoperative bleeding and more number of grafted vessels. The off pump technique was better concerning the duration of intubation, the duration of hospitalization, less usage of norepinephrine, less usage of venous grafts, need for blood transfusion, low cardiac output, arrhythmia and infectious complications. The 2 groups were equal for the rest of results. The difference in results between the 2 groups was more evident in the subgroup of conserved EF with equal results between the 2 main groups in patients with low EF except for the need for blood transfusion with more need in the on pump group. The postoperative angiography for the patients done with off pump revealed very good results especially for the coronaries grafted on the surface of the heart with 94% with good permeability for grafts done on the LAD. Discussion. The equality between the 2 main groups concerning the preoperative risk factors made the difference is a result of the type of technique. The statistical difference between the 2 main groups was more evident in the subgroup of conserved EF. There was non-statistical difference with also better results for the off pump group in the subgroup of low EF. The follow up angiography results were very promising even for the difficult vessels as the marginals and PDA. Conclusion. Off pump technique for now is better for the patients with very low EF and for patients with conserved cardiac function. For the coming soon future the off pump technique is very promising for all patients going to do CABG operation.