Coronary artery bypass for heart failure in ischemic cardiomyopathy: 17-year follow-up

Area of Science:

• Cardiovascular Surgery
• Cardiology
• Heart Failure Research

Background:

• Coronary artery bypass grafting (CABG) application in ischemic cardiomyopathy and heart failure is established.
• Long-term outcomes (beyond 5 years) following CABG in these complex patient groups require further definition.

Purpose of the Study:

• To evaluate the long-term survival and clinical outcomes of angina-free patients with ischemic left ventricular dysfunction and advanced heart failure undergoing CABG.
• To identify predictors of mortality and cardiac events in this specific patient population.

Main Methods:

• Retrospective analysis of 45 consecutive angina-free patients with ejection fraction ≤0.35 and New York Heart Association (NYHA) functional class III-IV heart failure undergoing CABG (1988-1995).
• Preoperative myocardial viability assessment using positron emission tomography.
• Long-term follow-up with survival probability calculation at 1, 5, 10, and 15 years.

Main Results:

• 30-day mortality was 4.4%. Median follow-up was 117 months.
• 15-year survival probability was 44%. Cardiac events caused 88% of late deaths.
• Elevated left ventricular end-diastolic pressure (LVEDP) ≥25 mm Hg predicted increased mortality (hazard ratio 3x, p=0.02). LVEDP ≥20 mm Hg correlated with perioperative intraaortic balloon pump use (p=0.04).
• Independent predictors of survival included age >70 years and peripheral vascular disease.

Conclusions:

• CABG alone provides favorable long-term outcomes in carefully selected angina-free patients with ischemic systolic dysfunction and advanced heart failure.
• Diastolic dysfunction, indicated by elevated LVEDP, is a significant predictor of reduced long-term survival, even in the presence of viable myocardium.
• Most patients achieved NYHA functional class I-II at late follow-up, suggesting significant functional improvement for survivors.