Postoperative Functional Outcome After Off-Pump Versus On-Pump Coronary Artery Bypass Grafting Using Gated Myocardial SPECT: A Comparison by Propensity Score Analysis

Jong Jin Lee; Won Jun Kang; Jin Chul Paeng; Dong Soo Lee; Ki-Bong Kim; June-Key Chung; Myung Chul Lee

doi:10.1007/s13139-010-0025-0

Postoperative Functional Outcome After Off-Pump Versus On-Pump Coronary Artery Bypass Grafting Using Gated Myocardial SPECT: A Comparison by Propensity Score Analysis

Nucl Med Mol Imaging. 2010 Jun;44(2):110-5. doi: 10.1007/s13139-010-0025-0. Epub 2010 Apr 22.

Authors

Jong Jin Lee¹, Won Jun Kang², Jin Chul Paeng¹, Dong Soo Lee¹, Ki-Bong Kim³, June-Key Chung¹, Myung Chul Lee¹

Affiliations

¹ Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul, 110-744 Korea.
² Division of Nuclear Medicine, Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
³ Departments of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea.

Abstract

Purpose: We evaluated the short-term and mid-term differences in perfusion and function after off-pump and on-pump coronary artery bypass grafting (CABG) using gated myocardial single photon emission computed tomography.

Materials and methods: A total of 70 patients with coronary artery disease who underwent CABG were included based on the propensity score matching results from 165 patients. Thirty-five patients underwent off-pump and 35 patients on-pump CABG. Rest (201)Tl/dipyridamole stress (99 m)Tc-methoxyisobutylisonitrile gated single photon emission computed tomographies were performed preoperatively and postoperatively at short-term (103 ± 23 days after surgery) and mid-term follow-up (502 ± 111 days after surgery). Changes in left ventricular ejection fraction, end systolic volume, stress and rest segmental perfusion, and segmental wall thickening were compared between the two groups. The segments with preoperative rest (201)Tl uptake under 60% of maximum uptake were included in the segmental analysis.

Results: Left ventricular ejection fraction (P = 0.001) and end systolic volume (P = 0.008) showed significant improvement in both groups. There were no significant short-term and mid-term differences between the two groups in terms of left ventricular ejection fraction (P = 0.309) and end systolic volume (P = 0.938). Likewise, segmental rest (P = 0.178) and stress perfusion (P = 0.071), and systolic wall thickening (P = 0.241) showed significant improvement in both groups with similar time courses.

Conclusion: Off-pump CABG resulted in significant improvements in left ventricular ejection fraction, end systolic volume, and regional myocardial perfusion and function that are comparable to on-pump CABG at short-term and mid-term. Gated myocardial SPECT successfully revealed that off-pump CABG is as good as on-pump CABG from the viewpoint of myocardial perfusion and function.

Keywords: Cardiopulmonary bypass; Coronary artery disease; Gated myocardial single photon emission computed tomography; Off-pump coronary artery bypass grafting.