Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction (original) (raw)
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Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction
The Annals of Thoracic Surgery, 2009
Background. Coronary artery bypass grafting (CABG) is a well-accepted therapeutic strategy for patients with multivessel coronary artery disease and left ventricular dysfunction. The aim of the study was to evaluate longterm results after CABG in patients with preoperative left ventricular ejection fraction (LVEF) of 0.35 or less. Methods. Data from 302 consecutive patients (mean age, 62 ؎ 8.7 years) with LVEF of 0.35 or less who had undergone CABG were analyzed. Epinephrine and enoximone with or without norepinephrine were used to increase cardiac index. Intra-aortic balloon pump or left ventricular assist devices, or both, were used in case of postoperative low output syndrome. Results. Complete revascularization was achieved in 298 of 302 patients (98.7%); internal thoracic artery was used in 294 (97.4%). Operative mortality was 5.3%; independent predictors of operative mortality were emergency CABG (p ؍ 0.005), history of ventricular arrhythmias (p ؍ 0.007), and previous anterior myocardial infarction (p ؍ 0.05). At follow-up, all-cause mortality was 30.8%, and 10-year survival was 63% ؎ 4%; independent predictors of late all-cause mortality were history of ventricular arrhythmias (p < 0.0001), chronic renal dysfunction (p ؍ 0.0004), and diabetes mellitus (p ؍ 0.04). Cardiac death was 20.4%, and 10-year freedom from cardiac death was 73% ؎ 3.3%; independent predictors of cardiac death were history of ventricular arrhythmias (p ؍ 0.004), chronic renal dysfunction (p ؍ 0.03), and more than one previous anterior myocardial infarction (p ؍ 0.004). At 80 ؎ 44 months of follow-up, echocardiography showed significant LVEF improvement (0.43 ؎ 0.09 versus 0.28 ؎ 0.06, p < 0.0001). Ten-year freedom from myocardial infarction was 87% ؎ 3%. Conclusions. Excellent long-term results after CABG can be expected for patients with LVEF of 0.35 or less. Complete revascularization and internal thoracic artery grafting are associated with high freedom from myocardial infarction. Careful treatment of arrhythmias, diabetes, and renal dysfunction is necessary to improve longterm survival.
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.
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.
The Annals of Thoracic Surgery, 2002
Background. The aim of this study was to define the potential for long-term survival with severe left ventricular dysfunction after coronary bypass and to quantify any improvement in overall functional status. Methods. Left ventricular dysfunction was confirmed preoperatively and the long-term survival and functional outcome after bypass was determined by follow-up studies obtained during the span of a decade. Results. From 1/1990 to 12/1999, 86 patients with severe left ventricular dysfunction (mean ejection fraction, 0.18 ؎ 0.03; range, 0.10 to 0.20) underwent coronary artery bypass grafting. There were 10 perioperative deaths (11% mortality). The mean survival was 55 months (standard deviation ؎ 34 months; range, 2 to 141 months) with an actual 5-year survival rate of 59% (actuarial 5-year 65%, 10-year 33%). Echocardiography obtained between 1 and 6 months, 6 months and 1 year, 1 and 2 years, 2 and 4 years, 4 and 6 years, and 6 and 11 years showed the ejection fraction improved to 0.29 ؎ 0.08 (p < 0.001), 0.31 ؎ 0.14 (p < 0.002), 0.35 ؎ 0.08 (p < 0.001), 0.27 ؎ 0.10 (p ؍ 0.002), 0.36 ؎ 0.14 (p ؍ 0.004), and 0.30 ؎ 0.11 (p ؍ 0.004), respectively. At 1 to 6 months, 6 months to 1 year, and 1 to 2 years, the diastolic left ventricular dimension was unchanged, but the systolic left ventricular dimension decreased significantly from 5.02 ؎ 0.77 cm to 4.26 ؎ 0.91 cm (p ؍ 0.046), 3.98 ؎ 1.43 cm (p ؍ 0.08), and 4.10 ؎ 1.14 cm (p ؍ 0.07). The preoperative New York Heart Association classification for all patients improved from 2.8 ؎ 0.8 to 1.6 ؎ 0.7 (p < 0.001) after a mean of 53 months (standard deviation ؎ 34 months). Conclusions. Patients with severe left ventricular dysfunction can derive long-term benefit from coronary bypass through improved left ventricular contractility as documented by a significantly decreased systolic left ventricular dimension and increased ejection fraction. Successful bypass is associated with a 59% actual 5-year survival rate and significantly improved New York Heart Association functional class.
Circulation
Coronary artery bypass grafting (CABG) is indicated in patients with coronary artery disease and impaired ventricular function. However, earlier studies have suggested that prognosis of patients with severe left ventricular dysfunction is extremely poor. We used the APPROACH registry to derive contemporary estimates of prognosis associated with CABG for this high-risk patient population. The study group consisted of 7841 patients who had isolated CABG in the province of Alberta, Canada between 1996 and 2001. Patients with markedly reduced left ventricular function (ejection fraction [EF] <30%, Lo EF, n =430) were compared with those with moderate reduction in ventricular function (EF 30% to 50%, Med EF, n =2581) and those with normal left ventricular function (EF >50%, normal [Nl] EF, n=4830). The operative mortality was higher in the patient group with Lo EF (4.6%) compared with Med EF and Nl EF groups (3.4% and 1.9%, respectively, P<0.001). At 5 years, survival was 77.7% ...
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...
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).