Surgical on-pump beating-heart treatment of ischemic patients with low LF ejection fraction: immediate results
Objectives. The study compares the early results of on-pump beating-heart (ONBEAT) surgery versus conventional coronary artery bypass grafting (CABG) with cardioplegic arrest (ONSTOP) in patients with coronary artery disease and left ventricular dysfunction. Methods. In a single-center randomized trial, 60 patients operated for severe left ventricular dysfunction (EF<35%) between January 2012 and January 2014 were randomized to ONBEAT (n=30) or ONSTOP (n=30) cohorts. All patients received preventive hemodynamic support before surgery (determined by randomization): intra-aortic balloon pump or levosimendan. Preoperative, operative and postoperative variables were evaluated in both groups. Results. Preoperative characteristics were similar between both groups. The time of stay in the ICU was 3 (2; 5) days in the first group and 3 (2; 4) days in the second one (p = 0.2). In the ONBEAT group 62 distal anastomoses (30 arterial) were performed and in the ONSTOP group 70 distal anastomoses (30 arterial) were done (p = 0.3). Completeness of revascularization on the beating heart corresponded to that in the group with cardioplegic arrest. The presence of complications such as stroke (p = 1.0), renal failure (p = 0.5), respiratory events (p = 0.2) and heart failure (p = 0.5) did not differ significantly between the two groups. Atrial fibrillation tended to occur more often in the postoperative period in the ONSTOP group (p = 0.03). The concentration of troponin I at all stages of the study did not differ significantly between the two groups. Both groups showed a significant increase in LV ejection fraction postoperatively: the first group 30 (26; 33) to 34 (30; 39) %, (p = 0,009); the second group - 31 (27 and 33) to 35 (30; 37) % (p = 0.01). Hospital mortality in the first group was observed in 1 case and in the second one in two cases (p = 0.5). Conclusions. The on-pump beating heart technique has no advantages comparing with conventional CABG in cases of preventive hemodynamic support. Both techniques were comparable with regard to complications, hospital stay duration and in-hospital mortality.