Surgical coronary revascularization in severe left ventricular dysfunction
Chee Fui Chong1, Ali Akbar Fazuludeen, Christie Tan
1Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore. chong_chee_fui@hotmail.com
Insights
Surgical revascularization is a safe option for patients with severe left ventricular dysfunction, showing acceptable mortality and improved heart function post-surgery. This procedure offers benefits for high-risk cardiac patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Research
Background:
- Coronary artery disease (CAD) with severe left ventricular dysfunction presents significant surgical challenges.
- Surgical revascularization is a common intervention for these complex cases.
Purpose of the Study:
- To evaluate the safety and outcomes of surgical revascularization in high-risk patients with severe left ventricular dysfunction.
Main Methods:
- A cohort of 50 patients with severe left ventricular dysfunction (mean ejection fraction 19.7%) underwent surgical revascularization between September 2002 and May 2004.
- Data collected included patient demographics, EuroSCORE, surgical indications, graft numbers, and postoperative support requirements.
- Morbidity, postoperative cardiac function improvement, and 30-day mortality were assessed.
Main Results:
- The study included 50 high-risk patients (mean age 59) with indications including heart failure, angina, and left main stem disease.
- Postoperative support was frequently required, with 34% needing intra-aortic balloon pumps and 96% inotropic support.
- Morbidity included renal failure (10%) and fatal multiorgan failure (4%), with a 30-day hospital mortality of 8%.
Conclusions:
- Surgical revascularization can be performed with acceptable hospital mortality in patients with severe left ventricular dysfunction.
- A significant proportion of patients (61%) demonstrated improved left ventricular function post-surgery.
- The findings support surgical revascularization as a viable option for carefully selected high-risk cardiac patients.
Abstract:
Surgical revascularization in patients with coronary artery disease and severe left ventricular dysfunction is a common practice and poses a surgical challenge. From September 2002 to May 2004, 50 patients (47 men and 3 women; mean age, 59 +/- 9 years) with a mean preoperative ejection fraction of 19.7% +/- 3.2% underwent surgical revascularization. The mean EuroSCORE was 7.2 +/- 3.4. Indications for surgery were congestive heart failure in 8 patients (16%), angina in 20 (40%), ventricular arrhythmias in 4 (8%), and critical left main stem disease in 12 (24%). Twenty-two patients (44%) had emergency surgery for critical anatomy and unstable symptoms. The number of grafts per patient was 3.7 +/- 0.8. Seventeen patients (34%) required intra-aortic balloon pump support, 16 (32%) needed pacing, and 48 (96%) had inotropic support postoperatively. Morbidity included re-operation for bleeding (2%), acute renal failure (10%), hemodialysis (4%), and fatal multiorgan failure (4%). Postoperative (4.9 +/- 3.7 months) 2-dimentional echocardiography was available in 18 patients of whom 11 (61%) showed improved left ventricular function (range, 5% to 45%). Thirty-day hospital mortality was 8%. These data indicate that surgical revascularization can be performed safely with acceptable hospital mortality in high-risk patients with severe left ventricular dysfunction.
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