[Results of coronary artery bypass grafting in patients with impaired left ventricular systolic function]

Area of Science:

• Cardiovascular Surgery
• Cardiac Rehabilitation
• Interventional Cardiology

Context:

• Patients with left ventricular ejection fraction (LVEF) below 40% represent a high-risk group for cardiac procedures.
• Coronary artery bypass grafting (CABG) is a common intervention for coronary artery disease, but outcomes in patients with severely impaired LVEF are less understood.
• Pre-operative assessment included coronary arteriography, left-sided ventriculography, and in some cases, myocardial perfusion imaging with SPECT Tc-99m-MIBI.

Purpose:

• To evaluate the early and late clinical outcomes of CABG in patients with LVEF < 40%.
• To assess the incidence and management of postoperative complications, specifically low cardiac output syndrome.
• To determine the long-term survival and functional status following CABG in this high-risk cohort.

Summary:

• The study included 128 patients (mean age 58.3 years, 89.8% in CCS class III/IV) with LVEF < 40%.
• Perioperative mortality was 12.5%, with higher rates in patients with LVEF < 0.2. Low cardiac output syndrome occurred in 35.2% of patients, successfully managed with intra-aortic balloon pumping (IABP) in 65.9% of survivors.
• Twenty-four-month survival was 82.4%, with significant improvement in Canadian Cardiovascular Society (CCS) functional class and myocardial perfusion post-CABG.

Impact:

• CABG is associated with significant perioperative risks in patients with LVEF < 40%, primarily due to low cardiac output syndrome.
• Intra-aortic balloon pumping (IABP) is an effective treatment for low cardiac output syndrome, improving survival in this patient group.
• Despite the risks, CABG offers substantial long-term benefits, including improved circulatory sufficiency, functional capacity, and survival rates for patients with severely reduced LVEF.