Impact of off-pump coronary artery bypass grafting on in-hospital outcomes for patients with ischemic mitral regurgitation

Abstract

Objectives. Combined coronary artery bypass grafting (CABG) and mitral valve repair (MVR) are associated with prolonged cardiopulmonary bypass (CPB) and aortic clamping time. Off-pump CABG has been claimed to avoid physiologic derangements related to CPB and myocardial anoxia. However, the benefit of off-pump surgery during combined myocardial revascularization and MVR remains unclear. The objective of our study was to determine whether off-pump CABG could improve the results of CABG+MVR combination. Methods. This retrospective study includes 62 patients, who underwent CABG combined with mitral valve repair or replacement (MVR). Coronary surgery was performed before MVR. In 33 (53.1 %) cases CABG was done off-pump on a beating heart, while in the remaining 29 (46.9%) cases on-pump surgery was performed. Results. The CPB time was significantly lower when we used the off-pump technique: 91.0 vs. 141.0 min in the on-pump group (p<0.001). The aortic clamping time in the off-pump group decreased as well: 48.0 min vs. 97.0 min respectively (p<0.001). Hospital mortality for the entire cohort was 8.1%. Mortality in the groups (off-pump vs. on-pump) accounted for 6.1% vs. 10.3% respectively (p = 0.5). There were no significant differences between the groups regarding in-hospital morbidity. In the off-pump group the increase in ejection fraction was more pronounced: 9% vs. 5% (p = 0.03). Conclusions. Off-pump surgery during combined CABG+MVR reduces CPB and aortic clamping time, but doesnt lead to decreased mortality and morbidity. However, an off-pump technique results in a significant increase in left ventricular ejection fraction in the early postoperative period.

Keywords

• ИШЕМИЧЕСКАЯ МИТРАЛЬНАЯ РЕГУРГИТАЦИЯ
• OFF-PUMP ХИРУРГИЯ
• КОМБИНИРОВАННЫЕ ОПЕРАЦИИ