Survival After Isolated Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction (original) (raw)
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.
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% ...
Heart Asia, 2010
Background Traditionally, the Coronary artery bypass grafting (CABG) surgery outcomes of patients with low ejection fraction (EF) have been worse compared to patients with moderate to good left ventricular function. During the past decade, despite improvements in surgical techniques, the trend in the outcomes of these patients remained unclear. Aim We sought to determine the effect of left ventricular dysfunction on early mortality and morbidity and to specify predictors of early mortality of isolated CABG in a large group of patients EF#35%. Method We retrospectively analyzed data of 14 819 consecutive patients undergoing isolated CABG from February 2002 to March 2008 at Tehran Heart Center. Patients were divided into two groups based on their LVEF (EF#35% and EF>35%). Differences in case-mix between patients with EF#35% and those without were controlled by constructing a propensity score. Results Mean age of our patients was 58.769.5 years. EF#35% was present in 1342 (9.1%) of patients. Inhospital mortality was significantly increased univariate in EF#35%, while this association diminished after confounders were adjusted for by using the propensity score (p¼0.242). Following adjustment it was demonstrated that renal failure, cardiac arrest, heart block, infectious complication, total ventilation time, and total ICU hours were more frequent in patients with EF#35%. Conclusion We demonstrated EF#35% was not predictor of in-hospital mortality in patients underwent CABG. Careful preoperative patient selection remains essential in patients with EF#35% undergoing CABG.
Pakistan Journal of Medical and Health Sciences
Objective: To assess the in-hospital complications of patients undergoing coronary artery bypass grafting (CABG) with severe LV dysfunction and to recognize the risk factors for adverse outcomes. Methods: This was a prospective descriptive study, containing patients who underwent CABG from 01-June-2019 to 31-Jan-2022 with documented LVEF < 35%. 190 patients for has been selected for this study. Postoperative data in ICU and ward regarding morbidity, mortality, hemorrhage, cardiac arrest, pacemaker implantation, IABP insertion requirement, and discharge data were collected to determine early postoperative outcomes. Results: The study sample enrolled 190 patients with multivessel CAD with severe LV dysfunction (EF <35%), of all patients, 147 were male and 43 female. Post-surgery hemorrhage has been observed in 23 (12.1%) patients, 9 patients were taken for re-exploration. The average ICU stay of 5.1 ± 3.6 days and Overall hospital mortality was 14 (7.3%). Patients with LV dysfun...
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.
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).