[Coronary artery bypass grafting in patients with highly impaired ventricular function. Long-term outcome]

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.