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[The long-term results of aortocoronary bypass surgery in patients with a severe preoperative left ventricular
J M Caralps1, V Martí, J Chávez
1Unidad de Cirugía Cardíaca, Hospital de la Santa Creu i Sant Pau, Barcelona.
Insights
Coronary artery bypass surgery in patients with severe left ventricular dysfunction demonstrates low hospital mortality and acceptable long-term survival. This procedure effectively improves angina and heart failure symptoms in this high-risk group.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Left Ventricular Dysfunction Management
Context:
- Retrospective analysis of 50 patients with severe left ventricular dysfunction undergoing coronary artery bypass surgery over 11 years.
- High prevalence of unstable angina (66%) and advanced NYHA functional class (38% III-IV) preoperatively.
- Significant coronary artery disease, including three-vessel disease (70%) and left main trunk involvement (12%).
Purpose:
- To evaluate the short- and long-term outcomes of coronary artery bypass graft surgery in patients with severe left ventricular dysfunction.
- To assess hospital mortality, functional status improvement, angina relief, and long-term survival rates.
- To determine the efficacy and safety of surgical intervention in this challenging patient population.
Summary:
- Hospital mortality was low at 4% (2/50), primarily due to low cardiac output syndrome.
- Follow-up in survivors (mean 4.8 years) showed 88% were angina-free, with 35 patients in NYHA functional class I-II.
- Actuarial survival rates at 1, 3, and 5 years were 92%, 78%, and 75%, respectively (excluding non-cardiac deaths).
Impact:
- Coronary artery bypass graft surgery offers a viable treatment option for symptomatic angina in patients with severe left ventricular dysfunction.
- The procedure leads to significant improvements in angina symptoms and heart failure status.
- Acceptable long-term survival rates support the consideration of surgical revascularization in carefully selected patients with reduced ejection fraction.
Abstract:
We analyze retrospectively the short- and long-term results of coronary artery bypass surgery in 50 patients with severe left ventricular dysfunction operated in a period of 11 years. Sixty-six percent of patients had unstable angina and 12% of total presented angina post-acute postmyocardial infarction. Thirty-eight percent of patients were in preoperative functional class III-IV of NYHA. Three-vessel disease was present in 70% of the patients, two-vessel in 30%, and the main trunk was affected in 12% of the global. Hospital mortality was 4% (2/50) due to low cardiac output syndrome. Follow-up was available in all the survivors and ranged 6 months-11 years (mean: 4.8 +/- 3.1). During follow-up, 13 patients died, but in only six was due to cardiac cause. The 35 patients followed were in functional class I-II of NYHA. Eighty-eight percent of the patients were angina free at follow-up. Actuarial analysis, after exclusion of 3 patients who died of causes no directly related to the heart, showed an intrahospital survival rates of 96%; at first year was 92, at 3rd was 78%, and 5th year survival rates were 75%. In conclusion, patients with symptomatic angina and preoperative severe left ventricular dysfunction, coronary artery bypass graft has a low hospital mortality, is effective in improving angina and heart failure, and the long-term survival is acceptable.