[Myocardial revascularization in patients with ischemic heart disease and left ventricular dysfunction]

Operative morbidity and mortality in coronary artery bypass surgery has decreased over the last decades and coronary artery bypass surgery offers an increase in long-term survival in selected patients with lower ejection fraction. We do not know exactly the results of the surgery and evolution of our patients with chronic lower ejection fraction.

To evaluate clinical results of myocardial revascularization in patients with ischemic heart disease and chronic lower ejection fraction.

We analyzed the experience between January 2000 and December 2001 of patients with ejection fraction = 30% treated with surgical myocardial revascularization. The procedure was carried out with cardiopulmonary bypass and moderate hypothermia (30 degrees C), and myocardial protection with intermittent cold crystalloid cardioplegia. We evaluated demographic characteristics, surgical procedure carried out, length-of-stay in intensive postoperative care unit, and morbidity and mortality in perioperative period and in middle term follow-up.

During this period, 738 patients were treated with aorto-coronary bypass surgery Thirty eight patients were patients with chronic lower ejection fraction (5.14%) and were included in this evaluation. Six patients were female (15.78%), and 32 males (84.21%). Range of duration of cardiopulmonary bypass was 65-245 min (mean, 123 min), range of aortic cross-clamping time was 30-120 min (mean, 59 min). Twelve month follow-up showed improvement in two functional classes in 15 patients (39.4%), and improvement in one functional class in 10 patients (26.3%); two patients remained in the same functional class (5.2%), and one patient decreased his/her functional class (2.6%). Mean of length-of-stay in intensive care unit was 6.5 days and in hospital, 12.5 days. Perioperative morbility was 34.2% and same-period mortality was 26%; 12 month survival was 74%. It was concluded that even with high mortality as in other series, survival and quality of life of these patients is better with than medical therapy.