\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,greek,english]{babel}



\usepackage{float}








\begin{document}

\title{Feasibility of off-pump coronary artery grafting for patients with
impaired left ventricular ejection fraction: a retrospective cohort
study from a single institutional database}



\author[1]{Rongrong Jiang}%
\author[1]{Yiqing Wang}%
\author[1]{Liewen Pang}%
\author[1]{Xiaotian Sun}%
\author[1]{Xianglin Chu}%
\author[1]{Fangrui Wang}%
\author[1]{Jiechun Huang}%
\affil[1]{Huashan Hospital Fudan University}%


\vspace{-1em}



  
  \date{May 25, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Despite great advances in surgeries, the management of patients with
impaired left ventricular ejection fraction is still challenging.
Furthermore, evidences on outcomes of off-pump coronary artery bypass
surgery (OPCAB) in this population are inconsistent. We conducted
present study to compare the short and long-term outcomes in patients
with different ejection fractions undertaken OPCAB.%
\end{abstract}%



\sloppy


\textbf{Type of article:} Original article

\textbf{Feasibility of off-pump coronary artery grafting for patients
with impaired left ventricular ejection fraction: a retrospective cohort
study from a single institutional database}

\textbf{Authors:} Rongrong Jiang\textsuperscript{1*}, Yiqing
Wang\textsuperscript{1*}, Liewen Pang\textsuperscript{1}, Xiaotian
Sun\textsuperscript{1}, Xianglin Chu\textsuperscript{1},Fangrui
Wang\textsuperscript{1},Jiechun Huang\textsuperscript{1**}

\textbf{Affiliations:}

\textsuperscript{1}Department of Cardiothoracic Surgery, Huashan
Hospital, Fudan University, Shanghai, P.R. China

\textbf{*} R.J. and Y.W have contributed equally to this work.

\textbf{**Corresponding authors:}

Jiechun Huang, MD.

Department of Cardiothoracis Surgery

Huashan Hospital, Fudan University

\#12 Wulumuqi Rd. (M), Shanghai, 200040 P.R.China

Tel.: +86 21 13003167575

Email:\emph{huangjiechun@huashan.org.cn}

\textbf{Key words:} Off-pump coronary artery bypass surgery; Left
ventricular dysfunction; Long-term outcomes; Propensity Score Matching

\textbf{Running title:} Rongrong Jiang \emph{et al} : OPCAB in impaired
left ventricular ejection fraction.

\textbf{Abstract:}

\emph{Objectives:} Despite great advances in surgeries, the management
of patients with impaired left ventricular ejection fraction is still
challenging. Furthermore, evidences on outcomes of off-pump coronary
artery bypass surgery (OPCAB) in this population are inconsistent. We
conducted present study to compare the short and long-term outcomes in
patients with different ejection fractions undertaken OPCAB.

\emph{Methods:} This retrospective cohort used data from the HuaShan
Cardiac-surgery Registry and included the consecutive patients aged [?] 18
years who were underwent OPCAB procedures during 2007-2019. Patients
included in the study were followed until death or the end of data
collection. Patients with different ejection fractions were matched 1:2
using propensity score matching. Factors associated with short-term
outcomes were determined using logistic regression and Kaplan-Meier
survival analyses for the differences of all-causes death were
generated.

\emph{Results:} The 2 propensity score-matched groups consisted of 40
LVD (left ventricular dysfunction) and 120 NLVF (normal left ventricular
function) patients, respectively. There were no statistical differences
in the postoperative outcomes between groups except for the occurrence
of left heart failure (22.5\% in LVD vs. 5.0\% in NLVF, \emph{p}
=0.009). Age (OR=1.11, 95\%CI: 1.04-1.18) but not the preoperative left
ventricular ejection fraction was shown in logistic regression to be a
strong predictor of experiencing short-term events. Kaplan-Meier curves
displayed a similar freedom from all cause death (\emph{p} =0.119) or
cardio-death (\emph{p} =0.092) between groups.

Conclusion: The immediately outcomes post-operation and the long-term
outcomes between groups are similar, indicating that OPCAB is a safe and
effective choice for left ventricular dysfunction patients.

\textbf{Keywords:}

Off-pump coronary artery bypass surgery; Left ventricular dysfunction;
Long-term outcomes; Propensity Score Matching

\textbf{Introduction}

The prevalence of coronary artery disease is rapidly increasing {[}1{]}.
In China, the prevalence is estimated at 4.6 per thousand residences of
all ages, effecting 5 million adults {[}2{]}. Coronary artery disease is
the most major cause of left ventricular dysfunction, commonly defined
in terms of reduced left ventricular ejection fraction (\textless{}50\%)
{[}2-4{]}. Coronary artery bypass graft (CABG) is the common type of
cardiac surgery worldwide. Paradoxically, there is strong evidence from
recent studies that left ventricular dysfunction is a predictor of early
mortality and a leading cause of high healthcare cost after conventional
coronary artery bypass grafting (cCABG), posing a great burden on both
patients and society {[}5, 6{]}.

Despite advances in surgical techniques, the management of patients with
decreased left ventricular ejection fraction is still challenging. Off
pump coronary artery bypass surgery (OPCAB) is an attractive alternative
in patients with impaired left ventricular function, comparing with
cCABG. The benefits of OPCAB theoretically were centered around the
avoidance of cardiopulmonary bypass and aortic manipulation, which were
endorsed by observations of avoiding the negative effects of
cardiopulmonary bypass on markers of inflammation, coagulation,
micro-embolization, thermoregulation, acid based balance, and regional
perfusion {[}7-9{]}. Substantially, positive short- and middle- term
outcomes of reducing morbidity and mortality were observed in study
{[}10, 11{]}. In light of these advantages, OPCAB now accounts for more
than 50\% of all CABG operations in China and other developing countries
{[}12{]}.

However, lifting and rotating the heart during OPACB potentially alter
such hemodynamics as left ventricular end-diastolic pressure, right
atrial pressure and cardiac outputs, as a result of the worsened
preservation of interventricular septal movement, the activation of
inflammatory mediators and the non-physiologic ventricular geometry of
the empty heart impeding collateral flow to ischemic areas {[}13{]}. The
decrease in short-term mortality seen with OPCAB may be negated by
reduced long-term graft patency, increased needs for repeat
revascularization procedures and inferior long-term survival compared
with CCAB in left ventricular dysfunction patients {[}14{]}. The
clinical evidence base surrounding OPCAB in this population remains
equivocal, ridden with biased observational studies, and relatively
small randomized trials {[}15{]}. Given these concerns, it may seem
still challenging for surgeons to take OPCAB procedure in patients with
left ventricular dysfunction.

To address some of the evidence gaps regarding prevailing practices in
management of patient with left ventricular dysfunction, we conducted
present study to compare the short and long-term outcomes in patients
with different ejection fractions undertaken OPCAB by the same surgeons
team, using the real-life registry database with an analysis of a
propensity score matching.

\textbf{Materials and Methods}

\emph{Study Design and Subjects}

This was a retrospective, matched cohort study using data from the
Hua-Shan Cardiac Surgery Registry. The consecutive coronary artery
disease patients aged [?] 18 years who were underwent OPCAB procedures
between 01 January 2016 and 31 December 2019 were enrolled. OPCAB were
performed by one fully trained cardiac surgeon team, whose members had
already performed a minimum of 50 off-pump operations. To be included,
eligible patients had to have continuous medical record during
preoperative, intraoperative and postoperative period. Patients were
excluded if they were unable to understand given information or were
reluctant to participate, had resection of ventricular aneurysm or re-do
cardiac surgery, were technically not feasible for OPCAB, and had other
logistic reasons that made routine follow up impossible.

Preoperatively, patient demographics were recorded. Patients were
divided into two cohorts determined by left ventricular ejection
fraction using the transthoracic echocardiogram: the left ventricular
dysfunction (LVD) cohort consisted of those who had LVEF\textless{}50\%,
and the normal left ventricular function (NLVF) cohort included patients
had LVEF[?]50\%. Intraoperative variables were documented for all cohorts.
All the eligible patients were periodically followed by on-site visit,
telephone call or mailed questionnaire up to 31 June 2020. During
on-site follow up, the computed tomographic angiography (CTA) or digital
subtraction angiography (DSA) were used to assess the graft and
echocardiography were used to measure the ventricular chamber size and
LVEF. The blood pressure, lipid profile and blood glucose level of
patients, which were directly associated with middle and long-term
outcomes of grafts, were monitored. Patients reported events of clinical
interest were collected and assessed systematically during follow up
stages.

The present study was approved by the Ethic Committee of Hua Shan
Hospital and conducted in concordance with Good Clinical Practice.

\emph{Operative Interventions}

Off-pump coronary artery bypass operations for both cohorts were
followed the standard care and processes of Hua Shan Hospital. In brief,
after general anesthesia and well prepared mechanical circulatory
support (both intra-aortic balloon pumps and extra-corporal circulation
units), patients were performed conventional median sternotomy incision
with harvesting of the left internal thoracic artery. Right internal
mammary artery and/or radial artery and saphenous vein graft was
performed as needed. Heparin was given at a low dose of 1 mg/kg to
achieve a target activated clotting time (ACT) of at least 280s before
ligation of the distal internal thoracic artery. The strategy of grafts
was decided after the pericardium opened and the size of target vessels
and heart assessed. Temporary stabilization of the target vessel
achieved by an Octopus tissue stabilizer (Medtronic, Inc., Minneapolis,
MN, USA) and if necessary supported with a deep pericardial traction
suture. Intraluminal shunts (ClearView Intracoronary Shunt; Medtronic)
and a blower mister (Guidant, Indianapolis, IN, USA) with carbon dioxide
and warm isotonic sodium chloride were used to remove blood from the
sites of arteriotomy and obtain a clear surgical field. An appropriately
sized intra-coronary shunt was placed to maintain perfusion of the
dependent myocardium and distal anastomosis performed using 7-0
polypropylene. Proximal anastomosis was done, if needed, using a partial
occluding vascular clamp on the ascending aorta, an aortomoy punch and
5-0 polypropylene. Ultrasounds were routinely used to measure the
patency and the flow of anastomosed grafts.

\emph{Definition of Variables}

The binary endpoints: middle-term mortality, first confirmed occurrence
of all cause death and cardio-death in relation to LVEF were evaluated.
Major cardiovascular disease included heart failure, angina, myocardial
infarction, atrial fibrillation and revascularization. Postoperative
respiratory failure was defined as prolonged ventilation for more than
72h resulting from respiratory causes, newly developed pulmonary edema,
adult respiratory distress syndrome, re-intubation due to respiratory
causes and tracheostomy.

\emph{Statistical Analysis}

Statistical analysis was performed using SPSS version 23 (IBM Corp.,
USA). Quantitative variables were expressed as means \selectlanguage{ngerman}± standard
deviation (SD) or medians and Interquartile Range {[}IQR, (25th
percentile, 75th percentile){]}. Categorical variables were reported as
numbers and percentages. Preoperative, intraoperative and postoperative
patients' characteristics were analyzed descriptively and compared among
cohorts with between-cohort differences assess using chi-squared tests
or Fisher's exact test for categorical variables and Wilcoxon rank-sum
tests for the continuous variables both before and after matching.

Propensity score matching was then used to mitigate underlying
differences in covariates between the cohorts, and a multivariable
logistic regression was used to build the propensity score model. Module
of Propensity score matching for SPSS (Version 3.0.4) was used. All
variables were retained in formulating the propensity score regardless
of statistical significance because they were believed to be clinically
relevant. Upon the estimation of propensity score, a greedy matching
algorithm matched the LVD cohort to NLVF cohort 1:2. To ensure pairs
were precisely matched on important covariates, the following variables
were exact-matched: age groups (\textless{}60 years vs \selectlanguage{english}[?]60 years) and
gender. Only patients with complete data sets were used in the creation
of the propensity score.

Kaplan-Meier analysis was then used to estimate time to all cause death
and cardio-death in LVD cohort versus NLVF cohort. To account for
pairing, between-cohort differences were assed using partial likelihood
ratio tests. Next, the number and proportion of patients who experienced
major cardiovascular disease within the follow up period was estimated,
and between-cohort differences were calculated using McNemar's test.

Multivariable Cox proportional hazard regression analysis was used to
quantify the relative risk of mid-term mortality in the LVD cohort
versus the NLVF cohort, controlling for covariates and stratified by
matched pairs. Statistical significance was accepted as a two-sided test
with an alpha level of 0.05.

\textbf{Results}

\emph{Study Population and Preoperative Characteristics}

A total of 307 patients underwent OPCAB were enrolled and stratified by
LVEF before matching. The two propensity score-matched groups consisted
of 40 LVD and 120 NLVF patients, respectively. The demographic and
preoperative characteristics of the patients both pre- and post-matching
are shown in Table 1. Compared with LVD group, the NLVF group had
significantly smaller proportion of smoker (34.9\% vs. 51.9\%;\emph{p}
=0.028), preoperative IABP (5.1\% vs. 25.0\%,\emph{p} \textless{}0.001)
and NYHA functional class III/IV (22.4\% vs. 61.5\%, \emph{p}
\textless{}0.001) before matching.

The matched-pairs had similar baseline characteristics expect for the
baseline LVEF, which was higher in the NLVF group (62.8+-6.70\% vs.
35.8+-5.98\%, p\textless{}0.001), indicating that the propensity model
had successfully served to remove the imbalance in distribution of a
number of prognostic factors. Patients with normal LVEF had slightly
higher proportion of obesity and CCS class3/4 angina compared to
patients in NLVF group, but no significant difference were found (48.8\%
vs. 40.0\%, 22.5\% vs.17.5\%, both \emph{p} \textgreater{}0.05).

\emph{Intraoperative Characteristics and In-hospital Outcomes}

Procedural characteristics (including emergent surgery and the number of
distal anastomosis) were also balanced between the 2 matched groups.
Complete revascularization was achieved in more than 80\% of the
patients. Inotropes were more widely used in LVD group (30.0\%
vs.13.8\%, \emph{p} =0.048). 77.5\% of patients in the LVD group and
92.5\% of patients in NLVF group were constructed three or more distal
anastomoses (with a single vein graft) (\emph{p} =0.037). Intraoperative
characteristics and early postoperative morbidity and mortality were
reported in Table 2. Patients in LVD group experienced significantly
higher prevalence of left heart failure than NLVF group (22.5\% vs.
5.0\%, \emph{p} =0.009). Despite higher postoperative major
cardiovascular disease and surgical wound infection rates in the LVD
group compared to the NLVF group, the difference did not reach
statistical significance. There were no statistical differences in the
postoperative occurrence of atrial fibrillation. There were no cases of
perioperative MI, TIA or CVA in both groups. The in-hospital mortality
was found to be similar before and after matching the preoperative
characteristics. The lower LVEF was associated with longer ventilation,
but the needs for ventilation more than 24h and/or respiratory failure
were similar. The medical resource utilization (length of ICU and
hospitalization stay) was similar in matched-pairs. Factors associated
with short-term outcomes (all causes in-hospital death, major
cardiovascular events or reoperation for bleeding) were assessed in the
multivariate logistic regression model. Table 3 shows the OR estimates
for predictors of short-term events in matched pairs. Importantly, age
(OR=1.11, 95\%CI: 1.04-1.18) but not the preoperative left ventricular
ejection fraction (OR=0.99, 95\%CI: 0.96-1.02) was shown to be a strong
predictor of experiencing short term events.

\emph{Long-term survival and outcomes}

A total of 209 patients the 2 groups (41 in LVD and 168 in NLVF),
accounting for 68.1\%, completed the planned follow-up. The median
duration of the observed period were 42.8 months (range: 0.2 to 81.5
months) in the matched LVD cohort and 43.6 months (range: 0.1 to 80.9
months) in the matched NLVF cohort. During follow up period, 11 patients
in LVD cohort and 11 patients in NLVF cohort died, with the long-term
survivals of 72.5\% and 90.8\%, respectively. Of them, 7 patients in LVD
cohort and 9 patients in NLVF cohort were cardiac death. The Kaplan
Meier survival estimates at one-, three- and five-years for LVD cohort
were 97.5\%, 81.8\% and 68.3\%; while those for NLVF cohort were 97.5\%,
88.2\% and 79.5\%. The 5-year freedoms from cardiac death were 74.8\%
and 86.3\% in LVD and NLVF cohort respectively (Figure 2). As shown in
Figure 1 and Figure 2, Kaplan-Meier curves displayed a similar freedom
from all cause death (\selectlanguage{greek}\emph{χ} \selectlanguage{english}\textsuperscript{2} = 2.431,\emph{p}
=0.119) or cardio-death (\selectlanguage{greek}\emph{χ} \selectlanguage{english}\textsuperscript{2} = 2.844,\emph{p}
=0.092) between the two groups.

\textbf{Discussion}

To the best of our knowledge, this study provides an up-to-date and
unique view of the association between preoperative LVEF and long-term
outcomes in patients after OPCAB surgery. In present study, we performed
a propensity score matching using a single-center surgery registry data
to investigate the disparities of long-term survival between LVD and
NLVF group, and the main findings of our study were as follows: 1) The
proportion of perioperative inotrope usage were significantly greater in
LVD group than NLVF patients, while the proportion of constructed three
or more distal anastomoses were more in NLVF group, indicating the
surgery management was more challenging for LVD patient intra-OPCAB; 2)
the risk of post-operative left heart failure was higher in LVD patient,
compared with NLVF patients, and 3) both early postoperative and
long-term outcomes are similar regardless of preoperative LVEF. These
findings confirm the efficacy and safety of OPCAB utilization in
patients with reduced left ventricular ejection fraction. Furthermore,
these findings highlight the importance of initiatives to develop a
tailored surgery strategy for patients with LVD that is able to improve
surgical outcomes and optimize the long-term survival.

With the highly prevalent of coronary artery disease globally, and
increasing of comorbid with impaired LVEF, cardiac surgeons are facing
more patients with poor pre-condition. LVEF is the most widely used
clinical indicator of left ventricular systolic function and related the
cardiovascular risk in patient with heart failure. Results from CHARM
showed the risk of all-causes mortality and major cardiovascular event
were inversely and linearly associated with LVEF {[}16{]}. The risk of
stroke was more than doubled in patients with LVEF\textless{}15\%
{[}17{]}. OPCAB surgery avoids ischemic cardiac arrest during coronary
artery revascularization. A recent published study shows that OPCAB is a
safe and efficient choice for high risk patients with multiple organs
failure {[}18{]}. Given the improvement and advantages of OPCAB
procedure, more and more surgeons try to extend the suegery to high risk
patients, including female and Low LVEF patient {[}19, 20{]}.

Despite enthusiasm for OPCAB on the part of surgeons, widespread
adoption in China has been slower than anticipated. It is due, in part,
to a lack of definitive evidence whether OPCAB can be safe in LVD
patients. In a recent randomized control study, OPCAB and on-pump
techniques seemed to produce equivalent results, although OPCAB was
associated with a lower graft patency rate {[}21{]}. Given the
inconsistency of different report, the usage of OPCAB in LVD patients is
limited in real practice.

The major concern is high proportion of completed revascularization,
which reported to be an independent risk for all-cause mortality
(HR=1.8) {[}22{]}. ROOBY study and a meta-analysis demonstrated that
number of constructed distal anastomoses underwent OPCAB are lesser than
those underwent conventional CABG {[}14, 23{]}. Our study is in line
with above findings: the lower LVEF, the smaller proportion of
constructed 3 or more distal anastomoses (77.5\% vs 92.5\%,\emph{p}
=0.037). Meanwhile, the occurrences of complete revascularization are
not significantly different between groups (82.5\% vs 87.5\%, \emph{p}
=0.579). Preoperative IABP and using vascular shunt during operation to
construct distal anastomoses can help patients with reduced LVEF to
complete revascularization. Our results have significant implications
for clinical practice. OPCAB can be safely undergone for patients with
left ventricular dysfunction if well preoperative and intraoperative
management. Surgeons should attempt to personalized management strategy
for those patients.

\emph{Limitations}

The present study has several limitations. First, as a single site
study, the conclusion may not be applicable in general because of
difference in practice patterns. Second, patients were not randomly
assigned to either group. Therefore, selection bias may affect our
findings. To mitigate the effect of this selection bias on outcomes,
propensity score matching was used to identify well matched LVD and NLVF
patients for comparison. Third, the size of our cohorts are somewhat
small for comparison, but the statistical power of the analysis of
operative outcomes, which was performed to determine whether there was
enough power in this model. Last, incomplete follow up may bias our
results when patient who drop out are different from those who complete
follow-up. We have minimized this bias by incorporating innovative
prevention and retention strategies (such as proactive social media
interaction) into our design and implementation. We performed a
structured survey by telephone interview in patients who were lost to
follow-up to address this issue.

\emph{Conclusions:}

Despite of more challenging on LVD patients' management, the immediately
outcomes post operation, and the long-term outcomes are similar between
groups are similar, indicating that the OPCAB is as safe and effective
as conventional CABG in all patients, regardless of LVEF. Recognition of
the safety of OPCAB in impaired LVEF patients can support the
development of comprehensive choices for LVD patients' cardiac
surgeries. More longitudinal studies are needed to assess the safety of
OPCAB in real-world setting and to tailor interventions for LVD patients
accordingly.

\textbf{Funding:} None.

\textbf{Conflict of interest:} none declared.



\textbf{Figure Legend}

Figure 1. Kaplan-Meier Curve for Long-term Survival Post-OPCAB Surgery

Figure 2. Kaplan-Meier Curve for Freedom from Cardiac Death Post-OPCAB
Surgery

\textbf{Table 1.} Preoperative Characteristics Stratified by LVEF\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
& Pre-matching & Pre-matching & Pre-matching & Post-matching &
Post-matching & Post-matching\tabularnewline
\midrule
\endhead
& LVD (n=52) & NLVF (n=255) & p & LVD (n=40) & NLVF (n=80) &
p\tabularnewline
Age (years), mean\selectlanguage{ngerman}±SD & 66.0\selectlanguage{ngerman}±9.15 & 67.0\selectlanguage{ngerman}±9,51 & 0.167 & 68.0\selectlanguage{ngerman}±7.11 &
69.1\selectlanguage{ngerman}±8.45 & 0.478\tabularnewline
[?]60 years & 76.9\% (n=40) & 72.5\% (n=185) & 0.607 & 85..0\% (n=34) &
85.0\% (n=34) & 0.999\tabularnewline
Female & 13.5\% (n=7) & 20.0\% (n=51) & 0.334 & 12.5\% (n=5) & 12.5\%
(n=10) & 0.999\tabularnewline
BMI (kg/m2), mean\selectlanguage{ngerman}±SD & 24.2\selectlanguage{ngerman}±3.43 & 24.2\selectlanguage{ngerman}±2.93 & 0.335 & 23.5\selectlanguage{ngerman}±2.77 &
24.0\selectlanguage{ngerman}±2.73 & 0.363\tabularnewline
\textgreater{}24kg/m2 & 48.1\% (n=25) & 51.8\% (132) & 0.651 & 40.0\%
(n=16) & 48.8\% (n=39) & 0.438\tabularnewline
LVEF (\%), mean\selectlanguage{ngerman}±SD & 35.3\selectlanguage{ngerman}±5.87 & 62.9\selectlanguage{ngerman}±6.93 & 0.002 & 35.8\selectlanguage{ngerman}±5.98 &
62.8\selectlanguage{ngerman}±6.70 & \textless{}0.001\tabularnewline
Current Smoker & 51.9\% (n=27) & 34.9\% (n=89) & 0.028 & 47.5\% (n=19) &
38.8\% (n=31) & 0.433\tabularnewline
COPD & 11.5\% (n=6) & 10.6\% (n=27) & 0.808 & 12.5\% (n=5) & 11.3\%
(n=9) & 0.999\tabularnewline
Hypertension & 63.5\% (n=33) & 74.1\% (n=189) & 0.083 & 67.5\% (n=27) &
78.8\% (n=63) & 0.188\tabularnewline
Dyslipidemia & 11.5\% (n=6) & 12.2\% (31) & 0.999 & 12.5\% (n=5) &
15.0\% (n=12) & 0.788\tabularnewline
History of myocardial infarction & & & & & &\tabularnewline
Atrial fibrillation & 9.6\% (n=5) & 2.7\% (n=7) & 0.036 & 2.5\% (n=1) &
2.5\% (n=2) & 0.999\tabularnewline
Diabetes mellitus & 34.6\% (n=18) & 29.8\% (n=76) & 0.298 & 35.0\%
(n=14) & 30.0\% (n=24) & 0.678\tabularnewline
Previous PCI & 11.5\% (n=6) & 8.6\% (n=22) & 0.596 & 12.5\% (n=5) &
12.5\% (n=10) & 0.999\tabularnewline
History of TIA or CVA & 32.7\% (n=17) & 43.9\% (n=112) & 0.165 & 30.0\%
(n=12) & 42.5\% (n=34) & 0.233\tabularnewline
NYHA functional class III/IV & 61.5\% (n=32) & 22.4\% (n=57) &
\textless{}0.001 & 60.0\% (n=24) & 60.0\% (n=48) & 0.999\tabularnewline
CKD & 5.8\% (n=3) & 3.1\% (n=8) & 0.405 & 5.0\% (n=2) & 2.5\% (n=2) &
0.600\tabularnewline
CCS class 3/4 angina & 17.3\% (n=9) & 14.5\% (n=37) & 0.670 & 17.5\%
(n=7) & 22.5\% (n=18) & 0.636\tabularnewline
Left Main Lesions & 34.6\% (n=18) & 39.6\% (n=101) & 0.536 & 40.0\%
(n=16) & 38.8\% (n=31) & 0.999\tabularnewline
Triple vessels disease & 80.8\% (n=42) & 80.4\% (n=205) & 0.999 & 75.0\%
(n=30) & 77.5\% (n=62) & 0.820\tabularnewline
Preoperative IABP & 25.0\% (n=13) & 5.1\% (n=13) & \textless{}0.001 &
12.5\% (n=5) & 12.5\% (n=10) & 0.999\tabularnewline
\bottomrule
\end{longtable}

\emph{LVEF, left ventricular ejection function; SD, standard deviation;
BMI, body mass index; LVEF, left ventricular ejection function; COPD,
chronic obstructive pulmonary disease; PCI, percutaneous coronary
intervention; TIA, transient ischemic attack; CVA, cerebrovascular
attack; NYHA, New York Heart Association; CKD, chronic kidney disease;
CCS, Canadian cardiovascular society. Data are expressed as \% (n)
unless otherwise indicated.}

\textbf{Table 2.} Intraoperative Characteristics and Early Postoperative
Outcomes Stratified by LVEF\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Pre-matching\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Pre-matching\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Pre-matching\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Post-matching\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Post-matching\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Post-matching\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
LVD (n=52)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
NLVF (n=255)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
p\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
LVD (n=40)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
NLVF (n=80)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
p\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Intraoperative Characteristics\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Complete Revascularization\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
82.7\% (n=43)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
87.1\% (n=222)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.383\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
82.5\% (n=33)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
87.5\% (n=70)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.579\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Number of distal anastomoses[?]3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
82.7\% (n=43)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
88.2\%(n=225)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.261\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
77.5\% (n=31)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
92.5\% (n=74)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.037\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Usage of LIMA\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
76.9\% (n=40)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
72.9\% (n=186)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.608\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
77.5\% (n=31)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
73.8\% (n=59)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.823\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Inotrope usage\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
32.7\% (n=17)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8.2\% (n=21)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}0.001\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
30.0\% (n=12)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13.8\% (n=11)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.048\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Early Postoperative Outcomes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
In-hospital death\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1.9\% (n=1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1.6\% (n=4)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.999\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2.5\% (n=1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1.3\% (n=1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Major cardiovascular events\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
42.3\% (n=22)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
33.3\% (n=85)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.264\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
42.5\% (n=17)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
32.5\% (n=26)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.316\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Perioperative myocardial infarction\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.4\% (n=1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.999\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
N/A\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
TIA or CVA\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3.8\% (n=2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3.1\% (n=8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.680\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
N/A\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Atrial fibrillation\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
34.6\% (n=18)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
29.8\% (n=76)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.511\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
32.5\% (n=13)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
30.0\% (n=24)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.835\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Left heart failure\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
19.2\% (n=10)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6.7\% (n=17)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.012\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22.5\% (n=9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5.0\% (n=4)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.009\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Surgical wound infection\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3.8\% (n=2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2.0\% (n=5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.338\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5.0\% (n=2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2.5\% (n=2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.600\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Re-intbation\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5.8\% (n=3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3.1\% (n=8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.405\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5.0\% (n=2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6.3\% (n=5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Reoperation for bleeding\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2.7\% (n=7)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.607\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6.3\% (n=5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.168\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Blood Loss (ml, first 24h), median (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
505 (275, 810)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
435(282.5, 602.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.028\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
530(275, 888.8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
390(260, 622.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.103\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
ICU LOS (hour), median (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13.8 (8, 18.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8 (6, 16)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.304\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13(7.5, 18)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8.5 (6.2, 17.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.977\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Ventilation (hour), median (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13.38 (7.5, 17.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8 (5.8, 15.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.334\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13(7.4, 17)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8.1(6, 16)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.995\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Prolonged ventilation (\textgreater{}24 hours)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9.6\% (n=5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3.5\% (n=9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.068\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10.0\% (n=4)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10.0\% (n=8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Hospitalization LOS (day), median (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6 (6, 10)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6 (6,7)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.166\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6(6,10)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6(6, 7.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.078\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\emph{LVEF, left ventricular ejection function; IABP, intra-aortic
balloon pump; SD, standard deviation; LIMA, left internal mammary
artery; TIA, transient ischemic attack; CVA, cerebrovascular attack;
LOS, length of Stay. Data are expressed as n (\%) unless otherwise
indicated.}

\textbf{Table 3.} Independent predictor for short-term events in
multivariable logistic regression models\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
Variables & OR (95\%CI) & p\tabularnewline
\midrule
\endhead
Gender(male vs. female) & 0.859(0.229, 3.215) & 0.821\tabularnewline
Age ([?]60 years vs. \textless{}60 years) & 1.107(1.038, 1.181) &
0.002\tabularnewline
BMI (\textgreater{}24kg/m\textsuperscript{2} vs. [?]
24kg/m\textsuperscript{2}) & 1.080(0.914, 1.275) & 0.368\tabularnewline
Hypertension (yes vs. no) & 0.711(0.249, 2.029) & 0.523\tabularnewline
Diabetes (yes vs. no) & 0.463(0.168, 1.277) & 0.137\tabularnewline
Current smoker (yes vs. no) & 1.003(0.385, 2.613) & 0.995\tabularnewline
Dyslipidemia (yes vs. no) & 0.476(0.108, 2.107) & 0.328\tabularnewline
COPD (yes vs. no) & 0.550(0.126, 2.397) & 0.426\tabularnewline
Previous PCI (yes vs. no) & 2.380(0.667, 8.498) & 0.182\tabularnewline
NYHA function class III/IV (yes vs. no) & 1.147(0.458, 2.872) &
0.770\tabularnewline
History of TIA or CVA (yes vs. no) & 1.224(0.475, 3.158) &
0.676\tabularnewline
Triple vessels diseases (yes vs. no) & 0.992(0.383, 2.568) &
0.987\tabularnewline
LVEF ([?]50\% vs. \textless{}50\%) & 0.985(0.955, 1.017) &
0.353\tabularnewline
\bottomrule
\end{longtable}

\emph{CI, Confidence Interval; BMI, Body Mass Index; COPD, Chronic
obstructive pulmonary disease; PCI, percutaneous coronary intervention;
NYHA, New York Heart Association; TIA, transient ischemic attack; CVA,
cerebrovascular attack; LVEF,} left ventricular ejection
fraction\emph{.}

\textbf{References:}

\begin{enumerate}
\tightlist
\item
  Wong ND. Epidemiological studies of CHD and the evolution of
  preventive cardiology. Nat Rev Cardiol 2014;11:276-89.
\item
  Zhang XH, Hu ZL, Liu L. Coronary heart disease in China. Heart
  2008;94:1126-31.
\item
  Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham
  WT, et al. Characteristics and outcomes of patients hospitalized for
  heart failure in the United States: rationale, design, and preliminary
  observations from the first 100,000 cases in the Acute Decompensated
  Heart Failure National Registry (ADHERE). Am Heart J 2005;149:209-16.
\item
  Hwang SJ, Melenovsky V, Borlaug BA. Implications of coronary artery
  disease in heart failure with preserved ejection fraction. J Am Coll
  Cardiol 2014;63:2817-27.
\item
  Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, et
  al. Off-pump coronary artery bypass grafting provides complete
  revascularization with reduced myocardial injury, transfusion
  requirements, and length of stay: a prospective randomized comparison
  of two hundred unselected patients undergoing off-pump versus
  conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg
  2003;125:797-808.
\item
  Rantner B, Pohlhammer J, Stadler M, Peric S, Hammerer-Lercher A,
  Klein-Weigel P, et al. Left ventricular ejection fraction is
  associated with prevalent and incident cardiovascular disease in
  patients with intermittent claudication - results from the CAVASIC
  Study. Atherosclerosis 2015;239:428-35.
\item
  Mishra M, Malhotra R, Mishra A, Meharwal ZS, Trehan N. Hemodynamic
  changes during displacement of the beating heart using epicardial
  stabilization for off-pump coronary artery bypass graft surgery. J
  Cardiothorac Vasc Anesth 2002;16:685-90.
\item
  Sepic J, Wee JO, Soltesz EG, Hsin MK, Cohn LH, Laurence RG, et al.
  Cardiac positioning using an apical suction device maintains beating
  heart hemodynamics. Heart Surg Forum 2002;5:279-84.
\item
  Song Y, Shim JK, Song JW, Shim CY, Kim EK, Kwak YL. Association of
  carotid arterial circumferential strain with left ventricular function
  and hemodynamic compromise during off-pump coronary artery bypass
  surgery. Circ J 2014;78:2422-30.
\item
  Letsou GV, Wu YX, Grunkemeier G, Rampurwala MM, Kaiser L, Salaskar AL.
  Off-pump coronary artery bypass and avoidance of hypothermic cardiac
  arrest improves early left ventricular function in patients with
  systolic dysfunction. Eur J Cardiothorac Surg 2011;40:227-32.
\item
  Youn YN, Chang BC, Hong YS, Kwak YL, Yoo KJ. Early and mid-term
  impacts of cardiopulmonary bypass on coronary artery bypass grafting
  in patients with poor left ventricular dysfunction: a propensity score
  analysis. Circ J 2007;71:1387-94.
\item
  Gayes JM. Off-pump coronary artery bypass in underdeveloped countries.
  J Cardiothorac Vasc Anesth 2000;14:762-3.
\item
  Head SJ, B\selectlanguage{ngerman}örgermann J, Osnabrugge RL, Kieser TM, Falk V, Taggart DP,
  et al. Coronary artery bypass grafting: Part 2--optimizing outcomes
  and future prospects. Eur Heart J 2013;34:2873-86.
\item
  Jarral OA, Saso S, Athanasiou T. Off-pump coronary artery bypass in
  patients with left ventricular dysfunction: a meta-analysis. Ann
  Thorac Surg 2011;92:1686-94.
\item
  Samad Z, Shaw LK, Phelan M, Ersboll M, Risum N, Al-Khalidi HR, et al.
  Management and outcomes in patients with moderate or severe functional
  mitral regurgitation and severe left ventricular dysfunction. Eur
  Heart J 2015;36:2733-41.
\item
  Meredith PA, Ostergren J, Anand I, Puu M, Solomon SD, Michelson EL, et
  al. Clinical outcomes according to baseline blood pressure in patients
  with a low ejection fraction in the CHARM (Candesartan in Heart
  Failure: Assessment of Reduction in Mortality and Morbidity) Program.
  J Am Coll Cardiol 2008;52:2000-7.
\item
  Di Tullio MR, Qian M, Thompson JL, Labovitz AJ, Mann DL, Sacco RL, et
  al. Left Ventricular Ejection Fraction and Risk of Stroke and Cardiac
  Events in Heart Failure: Data From the Warfarin Versus Aspirin in
  Reduced Ejection Fraction Trial. Stroke. 2016;47:2031-7.
\item
  Hlavicka J, Straka Z, Jelinek S, Budera P, Vanek T, Maly M, et al.
  Off-pump versus on-pump coronary artery bypass grafting surgery in
  high-risk patients: PRAGUE-6 trial at 30 days and 1 year. Biomed Pap
  Med Fac Univ Palacky Olomouc Czech Repub 2016;160:263-70.
\item
  Emmert MY, Salzberg SP, Theusinger OM, Rodriguez H, Sündermann SH,
  Plass A, et al. Off-pump surgery for the poor ventricle? Heart
  Vessels. 2012;27:258-64.
\item
  Puskas JD, Kilgo PD, Kutner M, Pusca SV, Lattouf O, Guyton RA.
  Off-pump techniques disproportionately benefit women and narrow the
  gender disparity in outcomes after coronary artery bypass surgery.
  Circulation 2007;116:I192-9.
\item
  Borde DP, Asegaonkar B, Apsingekar P, Khade S, Futane S, Khodve B, et
  al. Intraoperative conversion to on-pump coronary artery bypass
  grafting is independently associated with higher mortality in patients
  undergoing off-pump coronary artery bypass grafting: A
  propensity-matched analysis. Ann Card Anaesth 2016;19:475-80.
\item
  Nakano J, Okabayashi H, Noma H, Sato T, Sakata R. The impact of
  incomplete revascularization and angiographic patency on midterm
  results after off-pump coronary artery bypass grafting. J Thorac
  Cardiovasc Surg 2014;147:1225-32.
\item
  Topkara VK, Cheema FH, Kesavaramanujam S, Mercando ML, Cheema AF,
  Namerow PB, et al. Coronary artery bypass grafting in patients with
  low ejection fraction. Circulation. 2005;112:I344-50.
\end{enumerate}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Fig-1/Fig-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Fig-2/Fig-2}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

