Coronary by-pass for bad ventricle; adoption of "hybrid-pump" bypass

BACKGROUND The outcomes of on-pump and hybrid-pump bypass surgery in patients with depressed left ventricular function (EF<30%) were analyzed. METHODS 109 patients with preoperative left ventricular ejection fraction of <30% and bypassable circumflex coronary disease were randomized in a double blind fashion to undergo hybrid-pump (combination of off-pump and on-pump) procedure (54 patients), or on-pump coronary bypass (55 patients). In patients who underwent hybrid-pump procedure only circumflex system was bypassed on-pump to shorten CPB and myocardial ischemic time. Pre- peri and postoperative variables were analyzed. RESULTS Mean LVEF 24.4 +/- 4.8%. The patients in hybrid-pump group received less graft than others, but difference was not significant. Duration of the surgery was not different statistically between hybrid-pump and on-pump groups. A longer intraoperative duration of ischemia and extra corporeal circulation was found in on-pump group. Significant improvement in the postoperative course such as shorter mechanical ventilation, less catecholamines and IABP usage, less ICU and hospital stay, less stroke, less need for hemodyalisis and most importantly less hospital mortality was observed in hybrid-pump group. CONCLUSION Shortening the CPB and myocardial ischemic time and avoiding related problems, adoption of hybrid-pump strategy, in patients with severely impaired LVEF and bypassable circumflex coronary disease results in better outcome than conventional on-pump bypass.