Low ejection fraction is not a contraindication to off-pump coronary artery surgery.

Abstract

Patients with coronary artery disease (CAD) and severe left ventricular dysfunction (LVD) have a bleak prognosis despite recent advances in medical therapy, with an estimated two-year survival rate of only 30% [Isom 1975, Cosgrove 1984]. Although cardiac transplantation is an effective treatment for end stage cardiomyopathy, limited donor availability and high mortality among patients on the waiting list make transplantation an increasingly limited option. Myocardial revascularization prevents further ischemic injury to functional myocardium, restores function to hibernating myocardium, and has been shown to improve survival in patients with moderate to severe LVD [Isom 1975, Faulkner 1977]. Three large control trials of coronary artery bypass grafting (CABG) versus medical management have shown that patients with three vessel CAD and mild to moderate LVD (35%-50%) have better survival with CABG [Faulkner 1977, Tyras 1984, CASS 1983]. Cohort studies [Bounous 1988] of patients with LVEF of < 35% have shown that it is exactly this population of patients who will benefit most from revascularization, particularly if they have symptoms of angina. It is difficult to predict the actual operative mortality in patients with severe left ventricular dysfunction who undergo CABG. When only patients with LVEF, less than 35% are considered. Results of CABG are confusing because mortality rates range from 1.6% to almost 40%