Coronary artery bypass graft surgery in patients with ischemic cardiomyopathy and severe left ventricular
S F Oliveira1, A D Jatene, M C Solimene
1Heart Institute, Hospital das Clínicas, Medical School, University of São Paulo, SP, Brazil.
Insights
Myocardial revascularization improves survival and quality of life in ischemic cardiomyopathy patients. However, preoperative functional class IV congestive heart failure and left bundle-branch block predict poor outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Ischemic cardiomyopathy significantly impacts left ventricular function and long-term survival.
- Myocardial revascularization is a potential treatment option for these patients.
- Evaluating preoperative prognostic factors is crucial for patient selection and outcome prediction.
Purpose of the Study:
- To assess the prognostic value of preoperative parameters in patients with ischemic cardiomyopathy undergoing myocardial revascularization.
- To evaluate surgical risk, functional benefits, and long-term survival.
- To identify predictors of poor outcomes after myocardial revascularization.
Main Methods:
- Seventy-one patients with ischemic cardiomyopathy and severe left ventricular dysfunction (ejection fraction < 30%) were studied.
- Myocardial perfusion was assessed using Thallium-201 scintigraphy.
- Patients were followed for an average of 48 months post-myocardial revascularization.
Main Results:
- Early postoperative mortality was 2.8%, with a five-year survival rate of 62.8%.
- No correlation was found between survival and preoperative Q-waves, ischemia on scintigraphy, ejection fraction, or angina.
- Functional class IV congestive heart failure and left bundle-branch block were significantly associated with non-survival.
Conclusions:
- Myocardial revascularization is a safe procedure that enhances long-term survival and quality of life in selected patients.
- Preoperative prognostic parameters are challenging to establish due to heterogeneous disease patterns.
- Preoperative functional class IV congestive heart failure and left bundle-branch block are key predictors of adverse outcomes.
Background:
We evaluated the prognostic value of preoperative parameters, surgical risk, functional benefits and long-term survival after myocardial revascularization in patients with established ischemic cardiomyopathy.
Methods:
Seventy-one patients with ischemic cardiomyopathy, severe left ventricular dysfunction (left ventricular ejection fraction < 30%), and myocardial perfusion evaluated by Thallium-201 scintigraphy, were studied before and after myocardial revascularization, during hospitalization and throughout 48 months (average) of late follow-up.
Results:
The early postoperative mortality was 2.8% and the five-year survival rate was 62.8%. When the survival rate was studied, there was no correlation with 1) the presence of Q-waves on preoperative cardiogram, 2) the presence of ischemia on Tl-201 scintigraphy, 3) the degree of left ventricular ejection fraction, or 4) the presence of angina. There was a statistically significant difference for survivors and non-survivors in the following parameters: 1) functional class IV of CHF, and 2) the presence of left bundle-branch block (LBBB).
Conclusions:
Our surgical results confirm that myocardial revascularization is a safe procedure, and that it increases late survival and improves the quality of life in patients with ischemic cardiomyopathy and severe left ventricular dysfunction. We also observed that due to heterogeneous coronary and myocardial patterns of ischemic cardiomyopathy, preoperative prognostic parameters are difficult to establish. Preoperative functional class IV congestive heart failure, and LBBB were the main predictors of poor outcome following surgical revascularization for ischemic cardiomyopathy.
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