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Predictors of early outcome after coronary artery surgery in patients with severe left ventricular dysfunction
Naresh Trehan1, Surendra Nath Khanna, Yugal Mishra
1Escorts Heart Institute and Research Centre, Okhla Road, New Delhi 110025, India.
Insights
Left ventricular end-systolic volume index is the key predictor of survival in patients undergoing coronary artery bypass grafting for severe myocardial dysfunction. This finding aids in patient selection for improved surgical outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Surgical survival in severe myocardial dysfunction hinges on patient selection.
- Identifying prognostic factors is crucial for optimizing outcomes in these high-risk patients.
Purpose of the Study:
- To identify prognostic factors for surgical survival in patients with severe myocardial dysfunction.
- To determine the most significant predictors of outcomes after coronary artery bypass grafting.
Main Methods:
- Analysis of 176 patients with left ventricular ejection fraction < 30% undergoing isolated coronary artery bypass grafting.
- Evaluation of preoperative conditions including angina, recent myocardial infarction, and congestive heart failure.
- Statistical analysis including univariate and multivariate assessments of prognostic factors.
Main Results:
- Hospital mortality was 2.3% with low complication rates.
- Univariate analysis identified NYHA class, recent myocardial infarction, CHF, and LVESVI as predictors of survival.
- Multivariate analysis revealed left ventricular end-systolic volume index (LVESVI) as the sole independent predictor of survival.
Conclusions:
- Left ventricular end-systolic volume index is the most critical predictor of survival post-coronary artery bypass surgery in patients with severe myocardial dysfunction.
- LVESVI is a vital parameter for patient selection and risk stratification in this population.
Background:
The surgical survival in patients with severe myocardial dysfunction is critically dependent on the selection of patients. The present study was undertaken to identify the prognostic factors in such patients.
Methods:
We analyzed the data of 176 consecutive patients (161 men, 15 women), aged 29 to 88 years (mean 58.43), with a left ventricular ejection fraction (LVEF) < 30% who underwent isolated coronary artery bypass grafting. The LVEF ranged from 15% to 30% (mean 27.18%). Preoperatively, 33% had angina, 19.9% had recent myocardial infarction, and 21.6% had congestive heart failure. The mean number of grafts was 2.5/patient. The intra-aortic balloon was used prophylactically in 20.5% of patients and therapeutically in 4.0% of patients.
Results:
The hospital mortality was 2.3%. The complications occurred as follows: perioperative myocardial infarction in two (1.1%), intractable ventricular arrhythmias in two (1.1%), prolonged ventilation in four (2.3%) and peritoneal dialysis in 1 (0.6%). The mean ICU and hospital stay were 2.46 +/- 0.76 and 7.57 +/- 2.24 days, respectively. The predictors of survival on univariate analysis were New York Heart Association (NYHA) class (x2 = 14.458, p < 0.001), recent myocardial infarction (x2 = 5.852, p = 0.016), congestive heart failure (CHF) (x2 = 5.526, p = 0.019), and left ventricular end-systolic volume index (LVESVI) (x2 = 25.833, p < 0.001). However, on multivariate analysis, left ventricular end-systolic volume index was the only independent left ventricular function measurement predictive of survival (x2 = 10.228, p = 0.001).
Conclusion:
Left ventricular end-systolic volume index is the most important predictor of survival after coronary artery bypass surgery in patients with severe myocardial dysfunction.