Off Pump-Functional Complete Coronary Revascularization: Correlation between Preoperative and Postoperative Systolic Left Ventricular Function and Wall Motion Score Index

Background: Current study aims to evaluate outcomes after complete coronary revascularization and correlate outcomes with systolic left ventricular functions to assess effectiveness and significance of complete functional revascularization during off-pump coronary artery bypass grafting. Methods: Between 1st Jan 2023 and 30th Dec 2024, we received: 1) Fifty patients with ischemic hypokinetic one or more left ventricular segments (group-1 with hypokinesia) and 2) Fifty patients with severe hypokinetic segments and reduced segmental wall thickness (group-2 with severe hypokinesia and reduced wall thickness). Complete functional coronary re-vascularization was performed for all. They had echo-cardiography preoperatively, before hospital discharge, one, six and 12 months postoperatively. During this prospective cohort study, two patients had urgent postoperative coronary angiography. Results: Statistically significant differences between study groups regarding age and distribution of the degrees of stenosis. Age showed significant negative inverse correlation with preoperative systolic left ventricular functions. The degree of stenosis showed direct positive correlation with wall motion score and score index. Fifty percent of the patients in group-1 had 75% - 90% coronary artery stenosis, whereas 50% in group-2 had >90% stenosis. Left ventricular systolic functions showed statistically significant differences between preoperative and postoperative assessments during the study within both groups and between both groups. Significant direct positive correlation coefficient between ejection Fraction (EF) and mitral annular plane systolic excursion (MAPSE) measurements, as well as wall motion score and score index measurements. During the first 6 months of follow-up, there was a weak correlation between wall motion score and ejection fraction. Post-operative wound infection was recorded in 5 cases in both study groups. Myocardial infarction occurred in one case of group 1 and 2 cases of group 2. The two patients who had urgent postoperative coronary angiography, each had left internal mammary artery-to-left anterior descending graft stenosis, percutaneous coronary intervention with drug-eluting stent was an effective option. Conclusion: Complete off-pump functional surgical revascularization is highly recommended as it reverses ischemic myocardial changes; It is a significantly worthy recommendation that off pump is a safer and less invasive technique than on pump technique.