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[Myocardial revascularization in patients with severely depressed left ventricular function]
F Nicolini1, A Carcagnì, E Citterio
1Unità Operativa di Cardiochirurgia, Istituto Clinico Humanitas, Rozzano, MI.
Insights
Coronary artery bypass grafting (CABG) offers excellent outcomes for patients with severe left ventricular dysfunction and coronary artery disease. This high-risk surgery improves heart function and patient survival rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiology
Context:
- Patients with left ventricular dysfunction face increased risks during cardiac surgery.
- Coronary artery bypass grafting (CABG) in patients with ejection fraction < or = 0.30 presents significant surgical challenges.
- Advances in anesthetic and surgical techniques have improved outcomes for these high-risk patients.
Purpose:
- To evaluate the safety and efficacy of CABG in patients with end-stage coronary artery disease and severely reduced left ventricular ejection fraction (LVEF).
- To assess perioperative mortality, morbidity, and long-term outcomes in this specific patient cohort.
Summary:
- Fifty-one patients with LVEF between 16-30% underwent CABG.
- No operative or in-hospital deaths occurred; postoperative complications included low cardiac output syndrome (15.7%) and major neurological events (3.9%).
- Postoperative LVEF improved significantly (25.5% to 31.3%), with enhanced NYHA functional class and an excellent long-term prognosis.
Impact:
- CABG is a viable and effective treatment option for carefully selected high-risk patients with ischemic heart disease and severely impaired left ventricular function.
- The procedure significantly improves functional capacity, clinical outcomes, and life expectancy in this patient population.
- This study highlights the potential for successful surgical intervention in patients previously considered poor surgical candidates.
Background:
Improvements in anesthetic and surgical management of patients with left ventricular dysfunction have resulted in a decline in perioperative mortality and morbidity. Nevertheless, coronary artery bypass grafting (CABG) in patients with left ventricular ejection fraction < or = 0.30 remains a surgical challenge.
Methods:
Fifty-one patients with end-stage coronary artery disease and left ventricular ejection fraction between 16 and 30% underwent CABG. Mean age at operation was 66.1 +/- 7.85 years. Selection criteria included the clinical diagnosis of ischemic heart disease with angiographic demonstration of critical coronary artery obstructive lesions. Mean number of grafts per patient was 2.94 (range 1-5). Average duration of cardiopulmonary bypass was 74.5 +/- 22.4 min and mean aortic cross clamp time was 47.6 +/- 17 min.
Results:
No operative and in-hospital deaths occurred. Eight patients (15.7%) had postoperative low cardiac output syndrome, requiring intraaortic balloon counterpulsation. There were two major neurological complications (3.9%). There were four late deaths (7.8%), due to recurrence of untreatable congestive heart failure. Left ventricular ejection fraction increased from a mean of 25.51 +/- 4.75% preoperatively to 31.35 +/- 9.9% postoperatively (p < 0.001). Improvement in NYHA functional class (preoperatively 2.98 +/- 0.79 vs 2.35 +/- 0.6 postoperatively, p < 0.001) was found in this group at follow-up.
Conclusions:
CABG leads to an excellent prognosis in high risk patients with ischemic heart disease and low left ventricular ejection fraction, improving their functional and clinical outcome and consequently their life expectancy.