Thorac Cardiovasc Surg 2007; 55 - V_145
DOI: 10.1055/s-2007-967522

Off-versus on-pump CABG in patients with poor EF – a prospective, randomized single center study

B Podesser 1, C Holzinger 1, K Binder 1, M Vodrazka 1, W Haumberger 1, G Valicek 1, I Schor 1, R Pilazek 1, H Kassal 1
  • 1Landesklinikum St. Pölten, Herzchirurgie, St. Pölten, Austria

Objective: The subset of patients that benefits most from off-pump CABG remains controversial. This study compared off-with on-pump CABG in patients with poor EF.

Methods: 40 patients were randomized to undergo off- or on-pump CABG. Inclusion criteria were EF <30% and multi-vessel disease, exclusion criteria instable angina. The primary end-points were the time to extubation, hospital morbidity (neurological injury, renal or respiratory failure and perioperative MI), hospital and 3 months mortality. Data are presented as mean±SD (off versus on pump).

Results: EF was 26±4% versus 25±4%, EuroScore was 8±1 versus 7±1. Eighteen patients (70±6ys) had 3±1 grafts off-pump, 22 patients (71±5yrs) had 3.2±1 grafts on-pump. Time to extubation was 12±2.3h versus 16.1±2.1h (P<0.05). CK-MB was lower at the time-points 4, 12 and 24 hours (20±5, 21±7, 22±9 versus 36±7, 48±6 and 60±9 ng/ml; P<0.05). Inotropic support by dobutamine was similar between groups. There were no hospital deaths. Two off-pump (11%) compared to 5 on-pump (23%) patients presented a composite end-point (P<0.05). After 3 months, no patients in the off-pump (0%) compared to 3 patients in the on-pump (17%, 1 non-cardiac dead) had died (P<0.05).

Conclusion: These results suggest that off-pump CABG, if technically feasible, significantly reduces time to extubation, myocardial injury and 3 months survival in this high-risk cohort.