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Risk factors for mortality after coronary artery bypass grafting in patients with low left ventricular ejection
Jin Wang1, Feng Xiao, Jian Ren
1Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China. wj0463@yahoo.com
Insights
Coronary artery bypass grafting (CABG) patients with low left ventricular ejection fraction (LVEF) face distinct mortality risks. Aggressive treatment of mitral regurgitation and cardiac aneurysm improves outcomes in these high-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Risk Factor Analysis
Background:
- Identifying mortality risk factors after coronary artery bypass grafting (CABG) is crucial for surgical strategy.
- Special attention is needed for patients with low left ventricular ejection fraction (LVEF).
Purpose of the Study:
- To assess and confirm mortality risk factors following CABG.
- To guide surgical strategy, particularly for patients with LVEF ≤ 40%.
Main Methods:
- Retrospective analysis of 548 consecutive CABG patients (1999-2005).
- Eighty-nine patients had LVEF ≤ 40%.
- Twenty-two factors evaluated for association with perioperative death using univariate and multivariate logistic analysis.
Main Results:
- In all patients, LVEF, LVEDD, mitral regurgitation, cardiac aneurysm, and certain procedures were associated with mortality.
- In patients with LVEF ≤ 40%, age, LVEDD, mitral regurgitation, and CPB were univariate risk factors.
- Multivariate analysis identified moderate mitral regurgitation, cardiac aneurysm, and CPB as key risks in low LVEF patients.
Conclusions:
- Prognosis and risk factors differ significantly between all CABG patients and those with LVEF ≤ 40%.
- Low LVEF is an independent risk factor for perioperative death.
- Aggressive surgical correction of mitral regurgitation and cardiac aneurysm resection should be considered for patients with low LVEF undergoing CABG.
Background:
We managed to assess and confirm the risk factors for mortality after coronary artery bypass grafting (CABG) operations so as to map out the proper guidance of surgical strategy especially in patients with low left ventricular ejection fraction (LVEF) in domestic polyclinic like ours.
Methods:
Five hundred and forty-eight consecutive patients underwent CABG from December 1999 through August 2005 were analyzed retrospectively. Eighty-nine cases had an LVEF of 40% or less. All together twenty-two candidate factors were evaluated for their association with perioperative death using univariate and multivariate stepwise Logistic analysis.
Results:
When data from all the patients who had undergone CABG were taken into account, LVEF, left ventricular end diastolic diameter (LVEDD), mitral regurgitation, aneurysm of the heart wall, mitral repair/replacement, resection of aneurysm, concomitant aortic valve replacement, and perioperative intra-aortic balloon counter-pulsation (IABP), left ventricular assist device (LVAD) and cardiopulmonary bypass (CPB) all showed an association with perioperative death in univariate analysis, while an LVEF of > 40%, on the other hand, appeared to be a protective factor. In multivariate analysis, moderate to severe mitral regurgitation, aneurysm of the heart wall, repair of septal perforation and aortic regurgitation were proved to be risk factors. When the analysis was restricted to patients with an LVEF of 40% or less, such variables as age, LVEDD, mitral regurgitation, mitral repair/replacement, IABP, and CPB were qualified as risk factors in a univariate analysis. Age, moderate mitral regurgitation, aneurysm of the heart wall, CPB, left main coronary artery disease and female were associated with perioperative death in a multivariate logistic regression analysis.
Conclusions:
Concerning the prognosis, patients who undergo CABG would have different risk factors when data from all the enrolled patients or data from patients with LVEF
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