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[Can patients with severe left ventricular dysfunction be treated by coronary artery bypass surgery?]
X Tabone1, J P Metzger, O Thomas
1Hôpital Necker, clinique cardiologique, Paris.
Archives Des Maladies Du Coeur Et Des Vaisseaux
|November 1, 1992
Summary
Aorto-coronary bypass surgery is safe for patients with severe left ventricular dysfunction, significantly improving angina symptoms. However, a notable risk of cardiac failure persists, impacting long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Rehabilitation
- Interventional Cardiology
Context:
- Severe left ventricular dysfunction (ejection fraction < 35%) presents a high-risk profile for cardiac surgery.
- Patients often have a history of myocardial infarction and severe symptoms like unstable angina or congestive heart failure.
Purpose:
- To evaluate the safety and efficacy of aorto-coronary bypass surgery in patients with severely impaired left ventricular function.
- To assess perioperative risks, symptom relief, and medium-term outcomes, including mortality and cardiac events.
Summary:
- Forty-six patients (43 men, 3 women) with ejection fraction < 35% underwent bypass surgery, with 96% having prior infarction and 60% presenting with unstable angina.
- Operative mortality was low (2.1%), with significant angina regression (90% asymptomatic). Medium-term follow-up revealed 17% mortality at 2 years, primarily due to cardiac failure.
Impact:
- Aorto-coronary bypass surgery can be justified in symptomatic patients with severe left ventricular dysfunction, offering substantial angina relief.
- The study highlights a significant medium-term risk of cardiac failure, emphasizing the need for careful patient selection and management post-surgery.