Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction (original) (raw)
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Coronary artery bypass grafting in patients with severe left ventricular dysfunction
Cardiovascular Mohamed Fouad Ismail, et al. Cardiovascular Objectives: In patients with depressed left ventricular (LV) function (ejection fraction [EF] < 0.30), coronary artery bypass grafting (CABG) is the optimal therapeutic approach and remains superior to medical therapy. Patients and methods: 304 consecutive patients underwent isolated CABG, 57 patients had low ejection fraction (EF) < 30% (Group I) and 247 had EF > 30 % (Group II). Results: Mean age was 62 ± 2 years, 46 (79.7%) of them were males. Preoperative renal dysfunction and patients with history of prior myocardial infarction were statistically significant predominant in group I. Mean left ventricular ejection fraction was 25.3±4.3 in group I and 53.3±6.5 in group II. Left main trunk ste-nosis was significantly more (42.1%) in group I than group II (11.7%) (P<0.001). Preoperative intra-aortic balloon pump (IABP) to support the circulation was statistically significant. Aortic cross clamp time was longer in group II (mean = 112.8±14.1 min.) than group I (mean = 96.7±12.6 min.). Postoperative mechanical ventilation time was significantly longer in group I (mean = 29.1±8.2 hours). Intensive care unit and total hospital stay were statistically significant longer in group I (mean 8.3±4.6 and 12.6±6.1 days respectively). Arrhythmias were significantly more frequent in group I that had 8 patients (14.1%) while group II had only 11 patients (4.5%). Overall hospital mortality occurred in 3 patient (5.2%) died in group I, (P<0.001). Conclusion: Patients with ischemic heart disease and poor left ventricular function can be offered CABG with acceptable operative morbidity and mortality. Comprehensive assessment of the efficacy of the preoperative use of IABP requires a prospective randomized trial.
The Egyptian Heart Journal
Background: Coronary artery bypass grafting is known to be associated with better outcome in ischemic heart disease patients with low ejection fraction. We aim to demonstrate the effect of coronary artery bypass grafting (CABG) on left ventricle (LV) systolic function and to identify the predictors that adversely lead to postoperative poor outcome. Result: This is a cross-sectional prospective study; we included 110 patients with left ventricular ejection fraction (LVEF) < 50% who underwent CABG with a mean age of 56.1 ± 12.2 years old. Those patients were classified into two groups: group I, 76 (69%) patients with LVEF > 35%, and group II, 34 (31%) patients with LVEF < 35%. Our results as regards demographic and clinical data revealed that group II patients had a significantly higher prevalence of diabetes mellitus (DM) and Euro SCORE II compared to group I patients (p = 0.05 and < 0.001 respectively); otherwise, all other clinical predictors did not differ between the two studied groups. There was a significant improvement in LVEF post-surgery (p = 0.05) in both groups with observed no significant difference recorded for in-hospital mortality rate among patients with different groups. DM, significant diastolic dysfunction, and insertion of IABP are predictors of in-hospital mortality of the patients (p = 0.001, 0.03 and < 0.001, respectively) Conclusion: We concluded that there is a significant improvement of LV systolic function after CABG and hence better survival rate. DM, significant diastolic dysfunction, and perioperative insertion of IABP are predictors of mortality after cardiac surgery. Special care should be provided to such patients to improve their outcome
The American Journal of Cardiology, 1984
The effects of coronary artery bypass grafting (CABG) on ventricular performance and long-term clinical status were studied in 18 consecutive patients with disabling angina pectoris and severely depressed left ventricular (LV) performance (ejection fraction [EF] 27 4-9 % ). All patients survived CABG, although 1 patient had a perioperaUve myocardial infarction. There was no change in LVEF at rest, 29 -t-12%, in the other 17 patients. However, LVEF during peak exercise increased from 22 -I-7% to 27 -I-14% (p <0.05). The 17 patients were separated into 2 groups: those who increased their peak exercise LVEF by at least 10% (group A, 8 patients) and those who increased it by less than 10 % (group B, 9 patients). Preoperatively, patients in group A had a higher LVEF at rest (p <0.001) and smaller end-systolic and end-diastolic volumes at rest (p <0.001) and during exercise (p <0.005).
Circulation Journal
revascularization (IR) in patients with LV dysfunction due to ischemic heart disease. 5,9 In the present study, we investigated the long-term results after CR and IR in patients with LV dysfunction who underwent CABG. Methods We studied a consecutive series of 111 patients with LVEF ≤35% who underwent CABG at Mitsui Memorial Hospital between January 1994 and January 2014. The inclusion criterion was isolated first-time CABG. Exclusion criteria were previous cardiac surgery, combined procedures, recent myocardial infarction (MI), and cardiogenic shock at the time of index procedure. LVEF was preoperatively measured on echocardiography using the Simpson biplane method in all patients. The Institutional Review Board approved this retrospective study, and the need for written B ased on the current guidelines, coronary artery bypass grafting (CABG) is recommended as the preferred or reasonable therapy of choice for significant coronary artery disease (CAD) and severe left ventricular (LV) dysfunction (LV ejection fraction [LVEF] ≤0.35). 1,2 The results of the Surgical Treatment for Ischemic Heart Failure trial has supported these recommendations because of the long-term survival benefit of CABG over medical therapy in patients with significant CAD and severe LV dysfunction. 3,4 Therefore, CABG is considered the standard treatment for ischemic LV dysfunction; complete revascularization (CR) in such patients, however, remains controversial. Although CR is one of the most important goals of CABG, 5,6 CR is not always realistically achievable due to the variations in the complexity of coronary lesions as well as in the patient clinical status and characteristics, particularly in patients with LV dysfunction. 7,8 In addition, recent guidelines do not formally address the issue of CR in detail, and very few clinical studies to date have been conducted to evaluate the impact of CR vs. incomplete Editorial p 25
Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction
New England Journal of Medicine, 2011
Background The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established. Methods Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. Results The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P = 0.12). A total of 201 patients (33%) in the medicaltherapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P = 0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the followup period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG. Conclusions In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.
Chest, 1995
Study objective: The objective ofthe present study was to evaluate medium-and long-term results of coronary artery bypass grafting (CABG) in patients with severe left ventricular dysfunction (LVD). Design: Prospective evaluation (clinical follow-up and equilibrium radionuclide angiography scan) of all the patients with severe LVD who underwent CABG from November 1986 to November 1991 at the Tel Aviv Medical Center and were referred to the Post Cardiac Surgery Follow-up Clinic at this institution. Patients: Seventy-four consecutive patients (65 men, 9 women, aged 43 to 82 years; mean age, 68.2 years) with left ventricular ejection fraction (LVEF) of 30% or less who underwent isolated CABG (without automatic implantable cardioverter-defibrillator implantation, aneurysmectomy, valve replacement, or other open heart procedures) during a 5-year period and were discharged from hospitalization were prospectively evaluated. Preoperatively, 62% of patients had angina, 65% had congestive heart failure (CHF), andthe LVEF ranged from 10 to 30%. The mean number of grafts was 2.98 per patient; the internal mammary artery (IMA) was used in 54 patients. The patients were fol¬ lowed up 4 to 96 months (mean, 64.9 months) post-surgery for survival, clinical status, and left ventricular function. Results: Survivalwas 96%, 93.2%, 91.9%, 87.8%, 86.5%, 83.8%, and 83.8%, at 1, 2, 3, 4, 5, 6, and 7 years, respectively. Postoperatively, mean angina class im¬ proved from 2.9 to 1.4 (p<0.0001) and mean CHF class improved from 2.7 to 1.8 (p<0.0001). Mean LVEF im¬ proved from 23.5% preoperatively to 35.7% postop¬ eratively (p<0.0001). Conclusions: The following occur in patients with cor¬ onary artery disease and severe LVD undergoing CABG: (1) good medium-and long-term survival is at¬ tained; (2) angina class improves; (3) CHF class im¬ proves; (4) LVEF objectively improves; and (5). IMA can be used safely as a conduit.
Coronary artery bypass grafting in patients with advanced left ventricular dysfunction
The Annals of Thoracic Surgery, 1998
The aim of this study was to determine the long-term survival and control of angina in patients with coronary artery disease and sequentially decreased ejection fractions (EF) after first-time coronary artery bypass grafting. Methods. Between 1981 and 1995, 156 (1.3%) patients with an EF less than 0.25 (group 1), 588 (5%) patients with an EF of 0.25 to 0.34 (group 2), 2,438 (20.6%) patients with an EF of 0.35 to 0.49 (group 3), and 8,648 (73.1%) patients with an EF equal to or greater than 0.50 (group 4) underwent coronary artery bypass grafting. The EFs were determined by uniplanar or biplanar left ventriculography. For each group, the clinical and angiographic characteristics and the operative and outcome data were compared. Survival curves were derived and compared for each group. Correlates of angina, and of early (30-day) and long-term mortality, for all groups were analyzed. Results. For all groups the mean age was approximately 60 ؎ 10 years. Group 1 had the highest percentage of patients who were men (88%), had congestive heart failure (34%), had hypertension (53%), and had left main coronary artery disease (24%). Groups 1 through 3, compared with group 4, had a lower percentage of complete revascularization (p < 0.0001), a lower percentage of internal mammary artery grafts (p < 0.0001), and a greater use of intraaortic balloon pump (p < 0.0001), but had similar cross-clamp and cardiopulmonary bypass times, number of grafts, incidences of myocardial infarction, and stroke. Hospital mortality for groups 1, 2, 3, and 4 was 3.8% (n ؍ 6), 3.4% (n ؍ 20), 3% (n ؍ 72), and 1.6% (n ؍ 134), respectively. Groups 1 through 3, compared with group 4, had similar incidences of angina during follow-up (31% to 40% versus 33%, respectively; p < 0.06). Survival was greatest for group 4 compared with groups 1 through 3 at 1, 5, and 10 years (p < 0.0001). Patients in group 1 had 1-, 5-, and 7-year survivals of 90%, 64%, and 49%. Multivariate correlates of early mortality were advanced age, female sex, decreased EF, hypertension, diabetes, and emergency operation. Multivariate correlates of long-term mortality included severity of preoperative angina class, congestive heart failure, number of diseased vessels, and incomplete revascularization. The strongest correlates of angina at follow-up were younger age, female sex, previous myocardial infarction, lower ejection fraction, and incomplete revascularization. The absence of an internal mammary artery graft did not predict the occurrence of angina or influence long-term survival. Conclusions. In the long term there is a higher mortality in patients with sequentially decreased left ventricular function undergoing coronary artery bypass grafting, although more than 60% of patients with an EF less than 0.25 were alive and had good control of angina at 5 years despite having a higher percentage of risk factors, poorer functional status, and more complex coronary disease. Failure of symptom control and survival beyond 5 years appeared to be influenced by preexisting medical conditions and factors that affect the ability to completely revascularize the myocardium. These results suggest that in selected patients with ischemia and poor left ventricular function, coronary artery bypass grafting may preserve remaining viable myocardium, provide relief of symptoms, and offer survival greater than 60% at more than 5 years.
Kardiologia polska, 2008
Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction. The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction. A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS>120 ms or late potentials (LP) presence, QT dispersion ł80 ms, premature ventricular contractions (PVC) ł10/h, non-sustained ventricular tachycardia (nsVT), and SDNN Ł70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined. Fourteen patients died, 10 of them due to cardiova...