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[Coronary artery bypass grafting in patients with highly impaired ventricular function. Long-term outcome]
H Hausmann1, H Siniawski, R Meyer
1Abteilung für Herz-, Thorax- und Gefässchirurgie, Deutsches Herzzentrum Berlin, Germany. hhausmann@dhzb.de
Insights
Coronary artery bypass grafting (CABG) improves survival in patients with severe left ventricular dysfunction and viable myocardium. This high-risk group experiences acceptable long-term prognosis after CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Left ventricular function is a critical predictor of survival in coronary artery disease (CAD).
- Preoperative ventricular dysfunction significantly impacts hospital mortality after surgery for end-stage CAD.
- Investigating the influence of preoperative ventricular dysfunction on long-term survival after coronary bypass surgery is crucial.
Purpose of the Study:
- To evaluate the long-term survival outcomes of patients with severe left ventricular dysfunction undergoing coronary bypass grafting (CABG).
- To determine if preoperative identification of viable myocardium influences prognosis in these high-risk patients.
Main Methods:
- A cohort of 1751 patients with left ventricular ejection fraction (LVEF) of 10-30% underwent CABG between 1986 and 2000.
- Diagnosis of "hibernating myocardium" (ischemia) was confirmed using myocardial scintigraphy, echocardiography, MRI, and PET.
- Patient survival was tracked using actuarial methods.
Main Results:
- The operative mortality rate was 7.1%.
- Actuarial survival rates were 87.6% at 2 years, 76.0% at 5 years, and 53.3% at 9 years.
- For patients with LVEF 10-20%, survival rates were 79.8% (2 years), 63.0% (5 years), and 45.7% (9 years).
Conclusions:
- Coronary bypass grafting (CABG) can successfully enhance life expectancy for patients with end-stage coronary artery disease.
- Acceptable long-term prognosis is achievable for high-risk patients with preoperatively identified viable myocardium.
- CABG is a viable treatment option for selected patients with severe left ventricular dysfunction.
Background And Objective:
Left ventricular function is the most important predictor of survival in patients with coronary artery disease. It is also an important indicator for hospital mortality after operation for end-stage coronary artery disease. In our study we investigated, how preoperative ventricular dysfunction influences long term survival after coronary bypass surgery.
Patients And Methods:
Between 4/1986 and 12/2000, 1751 patients (1440 men/311 women) with left ventricular ejection fraction (LVEF) 10-30% underwent coronary bypass grafting (CABG) at the Deutsches Herzzentrum Berlin. The age of the patients was calculated to an average of 59,2 years. The prime criterion for CABG was ischemia ("hibernating myocardium") diagnosed by myocardial scintigraphy, echocardiography and in some cases with magnetic resonance imaging and positron emission tomography.
Results:
Operative mortality for the group was 7,1%. The actuarial survival rate was 87,6% after 2 years, 76,0% after 5, and 53,3% after 9. 455 had LVEF 10-20%, in these actuarial survival was 79,8% after 2 years, 63,0% after 5 and 45,7% after 9 years.
Conclusion:
We conclude that CABG can be used successfully to improve life expectancy of patients with end-stage coronary artery disease. CABG leads to acceptable prognosis for these high-risk patients when the myocardium is preoperatively identified as being viable.