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Predictors of outcome after coronary bypass surgery in patients with left ventricular dysfunction
Fatih Islamoğlu1, Anil Ziya Apaydin, Mustafa Ozbaran
1Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir. fislamoglu@hotmail.com
Insights
Coronary artery bypass grafting (CABG) is safe for patients with left ventricular dysfunction, even without viability tests. Older age and severe symptoms predict poorer outcomes after CABG surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Left ventricular dysfunction (LVEF ≤ 30%) poses challenges for cardiac surgery.
- Assessing myocardial viability pre-CABG is debated in patients with severe LV dysfunction.
Purpose of the Study:
- To identify risk factors for mortality and morbidity after CABG in patients with LV dysfunction.
- To evaluate the efficacy of CABG without preoperative viability assessment.
Main Methods:
- Retrospective analysis of 252 patients with LVEF ≤ 30% undergoing isolated CABG (1995-2000).
- No preoperative viability studies were conducted.
- Data included echocardiography, cardiac catheterization, and mid-term follow-up.
Main Results:
- Overall mortality was 16.27%, with a late mortality of 5.16%.
- Postoperative complications occurred in 24.21% of patients.
- Significant improvements in LVEF and functional class were observed post-CABG.
- Advanced age, diabetes, hypertension, prolonged cross-clamp/bypass times, and symptom severity (NYHA/CCS class III-IV) were associated with mortality. Multivariate analysis identified older age and severe functional class as independent predictors.
Conclusions:
- CABG can be performed safely in patients with LV dysfunction without viability assessment, showing favorable mortality and morbidity rates.
- Postoperative functional capacity and LVEF significantly improve after CABG.
- Advanced age and severe angina/functional status are key predictors of poor prognosis in this patient group.
Objective:
The aim of this study was to determine the risk factors affecting the mortality and morbidity after coronary artery bypass grafting (CABG) in patients with LV dysfunction and without any viability assessment.
Methods:
The preoperative, perioperative, and postoperative early and mid-term follow-up data of 252 patients with left ventricular ejection fraction (LVEF) of < or = 30% who underwent isolated CABG from 1995 through 2000, were evaluated. No preoperative viability study was performed for patient selection. Preoperative echocardiography and cardiac catheterization, and postoperative control echocardiography were performed in all patients. Follow-up data after the discharge of these patients were obtained via monthly periodical examinations in the first 6 months, and thereafter via telephone interviews. As preoperatively, 229 (90.87%) patients were in NYHA class III or IV, and the mean LVEF was 26.58 +/- 3.66%.
Results:
Overall mortality and late mortality rates were 16.27% and 5.16%, respectively. Postoperative complications were observed in 61 (24.21%) patients. During 49.06 +/- 15.17 months of follow-up, 185 (93.43%) of 198 (78.57%) survived patients were in NYHA class I or II and the mean LVEF was 39.64% +/- 5.68%. Advanced age, diabetes, hypertension, cross-clamp time > 60 min, bypass time > 120 min, severity of angina and functional classes (class III-IV of NYHA and CCS) were found to be the determinants of mortality. However, by multivariate analysis only older age and class III-IV of NYHA and CCS were detected as predictors of mortality.
Conclusion:
The low mortality and morbidity rates as well as postoperative improvements in functional capacity and in LVEF support the use of CABG without the need of any viability assessment in patients with left ventricular dysfunction. Advanced age, severe angina and functional symptom status seem to be the predictors of poor prognosis in these patients after CABG.