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

Objective: To compare myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular (LV) dysfunction. Methods: 117 patients with LV dysfunction (ejection fraction (EF)<35%) underwent coronary artery bypass surgery between January 1991 and July 1994. Sixty-four (group A) were operated on without a cardiopulmonary bypass, and 53 (group B) with one. 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 the internal mammary artery was used in 54 (84%) and 42 (79%) patients, respectively. Only 16 patients (25%) in group A received a graft to a circumflex 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-year survival was 86 and 65% (P = 0.04), respectively. Return of angina occurred in five (8%) and three (6%) patients (P = NS). Conclusions: These results show a trend for lower operative risk resulting in better overall survival in selected patients with LV dysfunction undergoing coronary artery bypass surgery without cardiopulmonary bypass.