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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Coronary bypass surgery for patients with chronic poor preoperative left ventricular function (EF<30%): 5-year
Jeremy Tan1, Nand Kejriwal, Arvind Vasudevan
1Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Verdun Street, Perth, WA 6010, Australia.
Insights
Coronary artery bypass surgery is safe and effective for patients with coronary artery disease and poor left ventricular function, even without viability testing. Early surgical intervention is recommended for improved outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Interventions
Background:
- Optimal therapy for coronary artery disease (CAD) with chronic poor left ventricular function remains unclear due to a lack of randomized trials.
- Coronary surgery in these patients is perceived as high-risk with unproven long-term benefits, particularly when viability testing is negative.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass surgery in patients with CAD and chronic poor left ventricular function.
- To assess the role of thallium scanning in predicting outcomes for these patients.
Main Methods:
- Retrospective analysis of 107 consecutive patients who underwent coronary surgery.
- Patient data collected via standardized questionnaire with a mean follow-up of 3.3 years.
- Multivariate analysis to identify predictors of perioperative death.
Main Results:
- Perioperative mortality was 1.9%. Factors predicting increased perioperative death included recent myocardial infarction and nonelective surgery.
- Kaplan-Meier 5-year survival was 72.3%, with 82.3% freedom from major adverse cardiac events.
- Thallium scanning failed to predict successful outcomes in 21 patients with limited myocardial viability.
Conclusions:
- Coronary surgery is safe and effective in the medium term for patients with CAD and poor left ventricular function, regardless of thallium testing results.
- Early surgical intervention is recommended for this patient group.
Background:
Optimal therapy for patients with coronary artery disease and chronic poor left ventricular function, given the absence of randomized trials, is unclear. Although coronary surgery has been performed in such patients for 25 years, it is perceived as high risk and unproven long-term benefit, especially if thallium scanning fails to demonstrate large areas of viability. We report the results of coronary surgery in these patients.
Methods:
Retrospective analysis by a standardized patient questionnaire, of 107 such consecutive patients offered coronary surgery.
Results:
Mean follow-up was 3.3 years (range, 0.5-5.5); average patient age was 64.4+/-1 years. Preoperative thallium scans were performed solely on 31 patients with none or mild angina, of which 10 (32%) demonstrated large areas of viable myocardium. Perioperative mortality was 1.9%. On multivariate analysis, factors predictive of increased perioperative death were recent myocardial infarction (p<0.001) and nonelective surgery (p<0.001). Kaplan-Meier 5-year survival and freedom from major adverse cardiac events were 72.3 and 82.3%, respectively. In 21 patients, with preoperative nil-to-mild angina and nil-to-small areas of myocardial viability, thallium scanning failed to predict a successful outcome.
Conclusion:
Offering coronary surgery to these patients irrespective of thallium testing is safe and effective in the medium term. Early surgery is recommended.
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