Complete revascularization in patients with severe left ventricular dysfunction
Hiroyuki Nishi1, Satoru Miyamoto, Shuichiro Takanashi
1Department of Cardiovascular Surgery, Osaka City General Hospital, Miyakojimahondori, Osaka, Japan.
Insights
Complete revascularization using multivessel coronary artery bypass grafting offers significant benefits for patients with coronary artery disease and severely depressed left ventricular ejection fraction (LVEF). This surgical approach improves heart function and survival rates, demonstrating safety and efficacy.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Patients with coronary artery disease (CAD) and severely reduced left ventricular ejection fraction (LVEF ≤ 30%) represent a high-risk group.
- Optimal revascularization strategies for this population remain a critical clinical question.
Purpose of the Study:
- To evaluate the benefits of complete revascularization via multivessel coronary artery bypass grafting (CABG) in patients with CAD and severely depressed LVEF.
- To assess the safety and long-term outcomes of this surgical approach.
Main Methods:
- A cohort of 42 patients with LVEF ≤ 30% underwent CABG with the goal of complete revascularization.
- The average preoperative LVEF was 23.8%, with a mean of 4.6 grafts per patient.
- Data collected included perioperative mortality, graft patency, LVEF improvement, and long-term survival.
Main Results:
- Hospital mortality was low (2.4%), with no 30-day mortality.
- Mean LVEF significantly improved postoperatively (23.8% to 35.2%, p<0.05).
- Five-year survival was 83.1%, and cardiac event-free survival was 77.5%, with improved NYHA classification in most patients.
Conclusions:
- Complete surgical revascularization using multivessel CABG is a safe and effective procedure for patients with poor left ventricular function.
- The strategy yields satisfactory hospital mortality and favorable long-term clinical outcomes, including improved survival and reduced cardiac events.
Objective:
This study evaluates whether patients with coronary artery disease and severely depressed left ventricular ejection fraction (LVEF) benefit from complete revascularization by multivessel coronary artery bypass.
Methods:
From April 1994 to May 2002, 42 patients who underwent coronary artery bypass grafting (CABG) at our institution had impaired left ventricular (LV) function [an ejection fraction (EF) of 30% or less]. The average preoperative LVEF was 23.8%. The mean number of grafts was 4.6. Complete revascularization by multivessel bypass grafting was the goal for all patients.
Results:
Thirty days mortality was 0 and hospital mortality was 2.4%. The mean graft patency rate for 35 (83%) patients at one month was 98.8%. The mean postoperative LVEF improved significantly, from 23.8% to 35.2% (p<0.05), and the New York Heart Association (NYHA) classification was improved in most patients. The Kaplan-Meier estimate of survival at 5 years was 83.1%, and that of the cardiac event-free rate at 5 years was 77.5%.
Conclusion:
For patients with poor LV function, complete surgical revascularization by multivessel bypass grafting can be performed safely, with satisfactory hospital mortality and long-term results.
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