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Comparison of complete and incomplete revascularization in CABG-patients with severely impaired left ventricular
U Boeken1, P Feindt, J Litmathe
1Department of Thoracic and Cardiovascular Surgery, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Insights
Complete revascularization in patients undergoing coronary artery bypass grafting (CABG) with severely depressed left ventricular ejection fraction (LVEF) improves outcomes. Accepting longer ischemia times for complete revascularization is beneficial for these high-risk patients.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) in patients with severely depressed left ventricular ejection fraction (LVEF < 30%) presents unique challenges.
- The optimal revascularization strategy, complete (CR) versus incomplete (ICR), remains unclear, balancing potential benefits of reduced ischemia against comprehensive myocardial reperfusion.
Purpose of the Study:
- To evaluate the impact of complete revascularization versus incomplete revascularization on outcomes in patients with severely depressed LVEF undergoing CABG.
Main Methods:
- A retrospective analysis of 263 patients with LVEF < 30% who underwent CABG between 1996 and 2000.
- Patients were divided into two groups: Group A (n=158) received CR, and Group B (n=105) received ICR due to inability to complete all intended grafts.
Main Results:
- Group A (CR) received more grafts per patient (3.59 vs. 2.92, p<0.05) and required less intraoperative catecholamine support (33% vs. 48%, p<0.05).
- Group B (ICR) experienced longer mechanical ventilation (20 vs. 12.1 h, p<0.05) and ICU stays (4.2 vs. 3.0 days, p<0.05), with a higher in-hospital mortality rate (6% vs. 3.2%, p<0.05).
Conclusions:
- Complete revascularization in patients with severely depressed LVEF undergoing CABG is associated with improved clinical outcomes.
- Accepting a potentially longer intraoperative ischemia time and cardiopulmonary bypass duration is justified to achieve effective revascularization in this patient cohort.
Objective:
CABG-procedures in patients with depressed LV-ejection fraction (LVEF) may still cause complications. In patients with severely impaired LVEF, it is particularly unclear whether a complete revascularization (CR) leads to a better outcome than the possible advantage of a short period of ischemia. This may be reached by a possibly incomplete revascularization (ICR).
Methods:
In our department, 263 patients with LVEF < 30% underwent a CABG-procedure between 1996 and 2000. Patients were divided into two groups with regard to their revascularization: group A patients (n = 158) received all grafts that were thought to be necessary according to preoperative angiography, whereas in group B (n = 105) at least one graft could not be realized.
Results:
Mean number of grafts per patient was 3.59 +/- 0.58 in group A and 2.92 +/- 0.47 in group B (p < 0.05). Intraoperatively, 33% of group A patients needed catecholamines, compared to 48% in group B (p < 0.05). IABP was used more often in group B (n = 7 compared to n = 3 in group A) (p < 0.05). Postoperatively, there were also significant differences: duration of mechanical ventilation (A: 12.1 +/- 3.4 h; B: 20 +/- 5.2 h) (p < 0.05) and stay on ICU (A: 3.0 +/- 0.6 days; B: 4.2 +/- 0.6 days) (p < 0.05) were significantly prolonged in group B patients. Six patients from group B died during hospitalization (6%), compared to five from group A (3.2%) (p < 0.05).
Conclusions:
In patients with a severely depressed LVEF, complete revascularization improves the outcome after CABG-procedures. A prolonged time of intraoperative ischemia and CPB can be accepted to realize an effective revascularization.
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