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Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency
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Risk stratification for coronary bypass surgery in patients with left ventricular dysfunction: analysis of the

M Argenziano1, H M Spotnitz, W Whang

  • 1Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA. ma66@columbia.edu

Circulation
|November 24, 1999
PubMed

Insights

Symptomatic heart failure and reoperation increase operative mortality in patients undergoing coronary artery bypass grafting (CABG) with ventricular dysfunction. Patients without heart failure symptoms can undergo CABG with lower mortality risks.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Preoperative patient characteristics significantly impact outcomes after coronary artery bypass grafting (CABG).
  • The CABG Patch Trial investigated prophylactic implantable cardioverter-defibrillator insertion in high-risk CABG patients.
  • This study utilized the CABG Patch Trial database to examine the influence of congestive heart failure (CHF) and angina on morbidity and mortality in patients with ventricular dysfunction.

Purpose of the Study:

  • To investigate the impact of symptomatic congestive heart failure (CHF) and angina on morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG) with ventricular dysfunction.
  • To identify predictors of increased operative mortality and prolonged length of stay (LOS) in this patient population.

Main Methods:

  • Analysis of data from 900 randomized patients with ejection fraction ≤35% and abnormal signal-averaged ECG.
  • Utilized single-variable and stepwise multiple logistic regression for mortality and LOS analysis.
  • Graded severity of CHF using NYHA classification and angina using CCS classification.

Main Results:

  • Perioperative mortality was higher in patients with symptomatic heart failure (7.7%) compared to those without (3.5%).
  • Symptomatic heart failure (NYHA class I-IV) and reoperation were significant predictors of increased mortality.
  • History of stroke was associated with a higher rate of perioperative stroke and increased LOS.

Conclusions:

  • Symptomatic heart failure and reoperation are key predictors of increased operative mortality in CABG patients with ventricular dysfunction.
  • Patients without heart failure symptoms may have relatively low mortality despite reduced ejection fraction.
  • Advanced age, history of stroke, and the presence/severity of heart failure significantly prolong LOS.
Abstract

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