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Coronary surgery with non-cardioplegic methods in patients with advanced left ventricular dysfunction: immediate and
P E Antunes1, J M Ferrão de Oliveira, M J Antunes
1Cardiothoracic Surgery, University Hospital, Coimbra, Portugal.
Insights
Non-cardioplegic coronary artery bypass grafting (CABG) is safe for patients with severe left ventricular (LV) dysfunction. This method offers low operative risks and good long-term survival rates for this high-risk group.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Severe left ventricular (LV) dysfunction poses significant risks during coronary artery bypass grafting (CABG).
- Evaluating alternative surgical techniques is crucial for improving outcomes in these patients.
Purpose of the Study:
- To assess the safety and efficacy of non-cardioplegic methods for CABG in patients with severe LV dysfunction.
- To analyze perioperative results and long-term survival in this patient cohort.
Main Methods:
- A retrospective analysis of 141 patients with LV ejection fraction < 30% undergoing isolated CABG using hypothermic ventricular fibrillation.
- Detailed data collection on patient demographics, surgical procedures, and perioperative outcomes.
- Long-term follow-up to determine late mortality and survival rates.
Main Results:
- Perioperative mortality was 2.8%, with an acute myocardial infarction rate of 2.8%.
- Low rates of inotrope requirement (35.5%), mechanical support (3.5%), and renal failure (3.5%).
- Actuarial survival rates at 1, 3, and 5 years were 96%, 91%, and 86%, respectively, with a late mortality of 11.5%.
Conclusions:
- Non-cardioplegic CABG techniques are safe and effective for patients with coronary artery disease and poor LV function.
- These methods demonstrate low operative mortality and morbidity.
- Encouraging medium to long-term survival rates support the use of this approach in selected patients.
Objective:
To evaluate perioperative results and long term survival in patients with severe left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) using non-cardioplegic methods.
Methods:
From April 1990 through December 1999, 4100 consecutive patients underwent isolated CABG using hypothermic ventricular fibrillation. Of these, 141 (3.4%) had severe LV dysfunction (ejection fraction < 30%). Mean age was 58.3 (9.6) years. 64 patients (45.4%) were in Canadian Cardiovascular Society class III or IV and 16 (11.3%) were subjected to urgent or emergent surgery. A previous myocardial infarction was recorded in 127 (90.1%). The majority (89.4%) had triple vessel and 26 (18.4%) had left main disease. The mean number of grafts per patient was 3.1. At least one internal thoracic artery was used in all patients and 21 (14.8%) had bilateral internal thoracic artery grafts (1.2 arterial grafts per patient).
Results:
Perioperative mortality was 2.8% (4 patients) and the incidence of acute myocardial infarction 2.8%. 50 (35.5%) patients required inotropes but only 16 (11.3%) required it for longer than 24 hours; 5 patients (3.5%) needed mechanical support. The incidence of renal failure was 3.5%. Mean duration of hospital stay was 9.6 (8.3) days. Follow up was 95% complete and extended for a mean of 57 (30) months. Late mortality was 11.5%. Actuarial survival rates at 1, 3, and 5 years were 96%, 91%, and 86%, respectively.
Conclusions:
Non-cardioplegic techniques are safe and effective in preserving the myocardium during CABG in patients with coronary artery disease and poor LV function, with low operative mortality and morbidity, and encouraging medium to long term survival rates.
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