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Coronary artery bypass grafting in patients with poor left ventricular function
Fatih Lslamoglu1, Anil Ziya Apaydin, Hakan Posacioglu
1Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
Japanese Heart Journal
|September 14, 2002
Summary
Coronary artery bypass grafting (CABG) is effective for patients with poor left ventricular ejection fraction (LVEF). This study found low mortality and improved LVEF and function, supporting CABG without viability tests.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Left Ventricular Dysfunction
Background:
- Coronary artery bypass grafting (CABG) in patients with poor left ventricular function (LVEF ≤ 30%) is challenging and controversial.
- Preoperative viability testing is often used for patient selection in these high-risk cases.
Purpose of the Study:
- To evaluate the effectiveness of isolated CABG in patients with severely reduced LVEF without case selection based on viability tests.
- To identify predictors of postoperative outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of 273 patients with LVEF ≤ 30% who underwent isolated CABG (1995-2000).
- Data included preoperative, perioperative, and early/mid-term follow-up (mean 49.5 months).
- Assessments included echocardiography, cardiac catheterization, and functional class (NYHA).
Main Results:
- Overall hospital mortality was 5.13% (14/273); late mortality was 16.12% (44/273).
- Postoperative improvement in mean LVEF from 26.5% to 39.6% was significant.
- 88.65% of patients preoperatively in NYHA class III/IV improved to class I/II postoperatively.
Conclusions:
- CABG can be performed safely and effectively in patients with severely impaired LVEF without preoperative viability assessment.
- Older age, NYHA class III-IV, and Canadian Cardiovascular Society (CCS) class were predictors of mortality.
- Satisfactory functional and LVEF improvements support CABG in this population.