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Coronary artery bypass grafting in patients with severe left ventricular dysfunction: predictive significance of left
J Vaskelyte1, N Stoskute, S Kinduris
1Cardiosurgery Clinic and Biomedical Research Institute of the Kaunas University of Medicine, Kaunas, Lithuania.
Insights
For patients with low ejection fraction undergoing coronary artery bypass grafting, a restrictive left ventricular filling pattern predicts higher mortality and complications. Impaired relaxation or pseudonormal patterns show better outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Severe left ventricular (LV) dysfunction (ejection fraction <35%) poses challenges for coronary artery bypass grafting (CABG).
- LV diastolic filling patterns can reflect myocardial health and influence surgical outcomes.
Purpose of the Study:
- To assess the impact of impaired LV diastolic filling on postoperative results in patients with low ejection fraction undergoing CABG.
Main Methods:
- 56 patients with LV ejection fraction <35% undergoing CABG were studied.
- Two-dimensional Doppler echocardiography assessed LV diastolic filling pre- and post-CABG.
- Patients were stratified into impaired relaxation, pseudonormalization, and restrictive filling groups.
Main Results:
- The restrictive filling group had the highest early postoperative mortality (33%) and cardiovascular complication rates (55.5%).
- Restrictive LV filling, early diastolic filling deceleration time, and LV end-diastolic diameter independently predicted perioperative mortality.
- LV systolic function showed minimal improvement in the restrictive group post-CABG.
Conclusions:
- A restrictive LV filling pattern is associated with significantly higher early mortality and morbidity after CABG in patients with severe LV dysfunction.
- Impaired relaxation and pseudonormal LV diastolic filling patterns correlate with better postoperative recovery and improved LV regional contraction.
- Echocardiographic assessment of LV diastolic function is crucial for predicting outcomes in CABG patients with reduced ejection fraction.
Aims:
The aim of our study was to evaluate the influence of left ventricular (LV) diastolic filling impairment on postoperative results in patients (pts) with low LV ejection fraction (EF) (<35%) undergoing coronary artery bypass grafting (CABG).
Methods:
The study covered 56 patients (mean age 58.9 +/- 17.1 years). Two dimensional Doppler echocardiographic investigations were performed pre- and 10-14 days post-CABG. Patients were divided into three groups according to the LV diastolic filling.
Results:
Early postoperative mortality rate (including perioperative period and 2 weeks after surgery) was highest in the restriction group (33%) vs. pseudonormalization (12.5%) vs. impaired relaxation (13.6%). Postoperative cardiovascular complications rate was highest also in the restriction group, 55.5%, and did not differ between pseudonormalization (25%) and impaired relaxation group (27.2%). Logistic regression analysis showed that restrictive LV filling pattern, early diastolic filling deceleration time and LV end-diastolic diameter independently influence perioperative mortality. In the early postoperative period mean LV wall motion score (WMS) did not improve in 8/19 (42%), 6/14 (43%) and 8/12 (67%) patients, respectively, in the impaired relaxation, pseudonormalization and restriction group.
Conclusions:
In patients with severe LV dysfunction undergoing CABG, impaired relaxation and pseudonormal pattern of LV diastolic filling correlated with postoperative improvement in LV regional contraction, while restrictive pattern correlated with high early postoperative mortality, morbidity and minimal improvement in LV systolic function. Restrictive LV filling pattern, early diastolic filling deceleration time and LV end-diastolic diameter were found to be independent predictors of perioperative mortality.
