Revascularization in patients with severe left ventricular impairment who have ischemic heart disease
Selim Erentürk1, Cenk E Yildiz, Murat Gulbaran
1Department of Cardiovascular Surgery, Istanbul University, Cardiology Institute, Turkey. selimerenturk@superonline.com
Insights
Coronary artery bypass grafting significantly improves left ventricular function and symptoms in patients with severe LV impairment. This procedure is recommended when myocardial viability is confirmed, offering an alternative to heart transplantation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Severe left ventricular (LV) impairment poses significant challenges in managing ischemic cardiomyopathy.
- Assessing the impact of surgical revascularization on LV function is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of coronary artery bypass grafting (CABG) on LV function, exercise capacity, and symptoms in patients with impaired LV function.
- To identify factors influencing outcomes after CABG in this patient population.
Main Methods:
- Retrospective analysis of 45 patients (mean age 63.49 years) with LV ejection fraction < 0.32 undergoing CABG.
- Preoperative and postoperative assessment of LV wall motion, New York Heart Association functional class, and risk factors.
Main Results:
- Significant improvement in mean LV ejection fraction from 26.64% to 32.98% (p<0.001).
- Mean New York Heart Association grade improved from 2.07 to 1.5 (p<0.001).
- Preoperative functional class, heart failure, arrhythmia, age, and complications were predictors of poor outcome.
Conclusions:
- CABG enhances global and regional LV function and improves symptoms in patients with severe LV impairment and myocardial hibernation.
- CABG is a recommended alternative to orthotopic heart transplantation when myocardial viability is demonstrated.
Objective:
To assess the effect of coronary bypass grafting on left ventricular (LV) function, exercise capacity and symptom profile in patients with LV impairment and retrospectively evaluate the role of the different factors affecting LV.
Methods:
A total of 45 patients (33 men, 12 women, mean age 63.49 +/- 7.38 years) with LV ejection fraction of less than 0.32 were admitted to the Istanbul University, Cardiology Institute, Istanbul, Turkey between January 2001 to June 2003 for coronary bypass operation. Preoperative and postoperative wall motion, functional class (New York Heart Association) and risk factors were analyzed.
Results:
We had one perioperative mortality (2.2%) and 2 early postoperative mortality (4.4%) due to poor cardiac function. There was a significant increase in the mean LV ejection fraction from 26.64 +/- 5.17 to 32.98 +/- 6.38 (p<0.001) postoperatively. In this group the mean New York Heart Association grade improved from 2.07 +/- 0.76 to 1.5 +/- 0.79 (p<0.001). Preoperative functional class, congestive heart failure, arrhythmia, age, pre/postoperative complications were the main predictors of poor outcome following surgical revascularization for ischemic cardiomyopathy.
Conclusion:
In patients with severe LV impairment with myocardial hibernation, coronary artery bypass grafting improves both global and regional LV function and symptom profile. We therefore, recommend a coronary artery bypass grafting as an alternative to orthotopic heart transplantation whenever myocardial viability are documented.
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