Royal College Lecture, 1976. Preoperative left ventricular ejection fraction and survival after coronary artery...

A preoperative ejection fraction (EF) of less than 0.30 slightly increases the immediate risk of myocardial revascularization. This risk can be greatly reduced by better myocardial protection and complete revascularization of the coronary lesions during surgery. Poor ventricular function, however, greatly influences the patient's long-term survival, especially when the EF is less than 0.30. In patients with coronary artery disease, in whom there are clinical and angiographic indications of an aortocoronary shunt and the EF, when measured in the right anterior oblique plane, is equal to or greater than 0.30, surgery may be performed with an acceptable surgical risk (3.9%) and satisfactory long-term (4- to 5-yr) survival (85%). When the EF is less than 0.30 it is necessary (before refusing operation) to conduct additional studies of venticular function such as biplane ventriculography, venticulography following the administration of nitroglycerin, epinephrine or after an artificially induced extrasystole. Isotope studies may also be considered, as they can reveal the presence of viable myocardial cells in the hypo- or akinetic segments.