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Published on: March 27, 2018

Predicting operative mortality after surgery for ischemic cardiomyopathy

Lynn M Fedoruk1, Curtis G Tribble, John A Kern

  • 1Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia 22908-0679, USA. lfedoruk@telus.net

The Annals of Thoracic Surgery
|May 29, 2007
PubMed

Insights

For ischemic cardiomyopathy, additional surgical procedures like mitral valve repair or left ventricular remodeling do not increase operative risk. Preoperative patient conditions and emergency surgery significantly impact mortality outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Heart Failure Research

Background:

  • Ischemic cardiomyopathy is a leading cause of heart failure, often lacking clear treatment algorithms.
  • Surgical interventions like coronary artery bypass grafting (CABG), CABG with mitral valve repair (CABG/MVR), and left ventricular remodeling (LVR) are considered.
  • The impact of additional procedures on operative risk and mortality requires further investigation.

Purpose of the Study:

  • To assess the operative risks and mortality associated with different surgical strategies for ischemic cardiomyopathy.
  • To determine if additional procedures (MVR, LVR) increase the risk compared to CABG alone.
  • To identify preoperative variables that influence surgical outcomes.

Main Methods:

  • Retrospective analysis of 382 patients undergoing cardiac surgery between 2000 and 2006.
  • Inclusion criteria: CABG with ejection fraction < 35%, ischemic mitral regurgitation, or LVR.
  • Analysis of Society of Thoracic Surgeons database for risks, complications, outcomes, revascularization completeness, and procedure types.

Main Results:

  • Overall operative mortality was 7.9%. Mortality rates were 9.1% for CABG, 8.2% for CABG/MVR, and 3.1% for LVR.
  • Preoperative risk factors for mortality included diabetes, cerebrovascular disease, and renal dysfunction.
  • Emergency operations and intra-aortic balloon pump use were associated with significantly increased mortality.

Conclusions:

  • Mitral valve repair and left ventricular remodeling do not add to the operative risk of CABG in ischemic cardiomyopathy.
  • Preoperative comorbidities and the urgency of the operation are the primary drivers of increased operative mortality.
Abstract

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