Survival After Isolated Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction (original) (raw)
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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 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.
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...