offpump total myocardial revascularization in patients with left ventricular dysfunction objective to assess offpump myocardial revascularization in patients with significant left ventricular dysfunctionmethods four hundred and five patients with an ejection fraction less than 35 underwent myocardial revascularization without extracorporeal circulation the procedure was performed with the aid of a suction stabilizer and the lima stitch the distal anastomoses were performed firstresults a total of 405 patients were evaluated whose mean age was 634 978 years two hundred and seventynine patients were men 688 with regard to risk factors 347 patients were hypertensive 194 were smokers 202 were dyslipidemic and 134 had diabetes two hundred and sixty patients were classified as nyha functional class iii and iv twenty patients suffered from chronic renal disease and were under dialysis fiftyone underwent emergency surgery and 33 had been previously operated on the mean ejection fraction was 272 354 the mean euroscore was 846 441 the mean number of anastomoses performed was 303 154 per patient fortynine patients 12 needed an intraaortic balloon inserted after induction of anesthesia whereas 73 18 needed inotropic support during the perioperative period as to complications 2 patients 049 had renal failure 2 had mediastinitis 049 7 17 needed to be reoperated because of bleeding 5 patients 12 suffered acute myocardial infarction and 70 patients 173 experienced atrial fibrillation eighteen 44 patients diedconclusion based on the data above we concluded that myocardial revascularization without extracorporeal circulation in patients with left ventricular dysfunction is a safe and effective technique and an alternative for highrisk patients results obtained were better than those predicted by euroscore