Comparison of myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular dysfunction

OBJECTIVE: To compare myocardial revascularization withoutcardiopulmonary bypass to standard open heart technique in patients withleft ventricular (LV) dysfunction. METHODS: 117 patients with LVdysfunction (ejection fraction (EF) < 35%) underwent coronary arterybypass surgery between January 1991 and July 1994. Sixty-four (group A)were operated on without a cardiopulmonary bypass, and 53 (group B) withone. Prevalence of EF < 20% (17 vs. 6%) and emergency operations (22 vs.7%, P = 0.03) was higher in group A. The average number of grafts was 1.9+/- 0.8/pt in group A and 3.5 +/- 0.9/pt in group B (P < 0.01), and theinternal mammary artery was used in 54 (84%) and 42 (79%) patients,respectively. Only 16 patients (25%) in group A received a graft to acircumflex marginal artery compared to 51 (96%) in group B (P < 0.0001).RESULTS: Two patients (3.1%) died perioperatively in group A compared to 7(13%) in group B (P = NS). In two patients from group A (3.1%) and in four(7.5%) from group B intra- aortic balloon pump was inserted postoperatively(P = NS). One year actuarial survival was 91 and 79% (P = 0.03) and 2-yearsurvival was 86 and 65% (P = 0.04), respectively. Return of angina occurredin five (8%) and three (6%) patients (P = NS). CONCLUSIONS: These resultsshow a trend for lower operative risk resulting in better overall survivalin selected patients with LV dysfunction undergoing coronary artery bypasssurgery without cardiopulmonary bypass.