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Coronary artery bypass in patients with severe left ventricular dysfunction
Dronamraju Dilip1, Mangu H Rao, Abha Chandra
1Department of Cardiovascular and Thoracic Surgery Sri Venkateswara Institute of Medical Sciences Tirupati, Andhra Pradesh, India. drdilip_d@yahoo.com
Insights
Coronary artery bypass grafting in patients with severe left ventricular dysfunction shows acceptable mortality. This surgery can significantly improve quality of life, moving patients from severe angina to a better functional class.
Area of Science:
- Cardiology
- Cardiac Surgery
- Internal Medicine
Background:
- Severe left ventricular dysfunction (ejection fraction < 30%) presents significant challenges for cardiac surgery.
- Patients with poor ejection fraction often have complex comorbidities, including hypertension, diabetes, and hypercholesterolemia.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass grafting (CABG) in patients with severe left ventricular dysfunction.
- To assess the impact of CABG on mortality, hospital stay, and quality of life in this high-risk patient group.
Main Methods:
- Retrospective review of 82 patients with ejection fraction < 30% who underwent CABG between March 1993 and February 2000.
- Analysis of perioperative mortality, hospital stay duration, and long-term functional status (Canadian Cardiovascular Society angina class).
Main Results:
- The study included patients aged 28-76 years, with a high prevalence of hypertension (93%) and diabetes mellitus (85%).
- Perioperative mortality within 48 hours was 9% (7 patients). Mean hospital stay was 7 ± 2 days.
- At 1-year follow-up, 90% of surviving patients improved from Canadian Cardiovascular Society angina class III to class I.
Conclusions:
- Coronary artery bypass grafting in patients with severe left ventricular dysfunction is associated with an acceptable mortality risk.
- CABG can lead to a significant improvement in quality of life and functional capacity in this patient population.
Abstract:
We retrospectively reviewed the case records of 82 patients with severe left ventricular dysfunction (ejection fraction < 30%) who underwent coronary artery bypass grafting between March 1993 and February 2000. They were aged 28 to 76 years (mean, 60 years), and 66 of them were male. Significant comorbid factors included hypertension (93%), diabetes mellitus (85%), and hypercholesterolemia (49%). The number of grafts used ranged from 1 to 3. The majority of the patients (91%) belonged to the Canadian Cardiovascular Society angina class III. Coronary angiography revealed single-vessel (in 16% of the patients), double-vessel (52%), and triple-vessel disease (32%), and left main stem disease (18%). Seven patients (9%) died within 48 hours after surgery. The mean duration of hospital stay was 7 +/- 2 days. The 75 patients who survived were followed up for 3 months to 7 years. At the 1-year follow-up, 61 of the 68 patients (90%) who were alive moved up from angina class III to class I. Our observations suggest that coronary bypass carries an acceptable mortality risk and may offer a better quality of life in patients with poor ventricular function.