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Long-term survival and functional recovery after isolated coronary artery bypass grafting in patients with severe
Toshihiro Fukui1, Toshihiko Shibata, Yasuyuki Sasaki
1Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, and Kansai Rosai Hospital, Hyogo, Japan. tfukui-cvs@umin.ac.jp
Insights
Coronary artery bypass grafting (CABG) is effective for patients with left ventricular dysfunction, showing improved heart function and acceptable long-term survival rates. Early graft patency was favorable in this patient group.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction presents significant surgical challenges.
- Assessing outcomes in this high-risk population is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the early angiographic and long-term clinical and functional outcomes of isolated CABG in patients with poor left ventricular function.
- To determine the efficacy and safety of CABG in this specific patient cohort.
Main Methods:
- Retrospective review of 78 patients with left ventricular ejection fraction ≤35% who underwent isolated CABG.
- Analysis of early postoperative angiograms, interval echocardiographic data, and long-term survival rates.
- Inclusion of patient demographics, New York Heart Association functional class, and mitral regurgitation grade.
Main Results:
- Mean left ventricular ejection fraction improved significantly post-CABG (28.2% to 34.4%).
- Left ventricular dimensions decreased, indicating improved cardiac function.
- 10-year actuarial survival rate was 73.1%, with high graft patency rates (arterial 100%, venous 97.2%).
Conclusions:
- Isolated CABG is an effective procedure for patients with left ventricular dysfunction.
- Favorable early graft patency and acceptable long-term outcomes, including functional recovery, support the use of CABG in this population.
Objective:
Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction has been considered to be a challenging operation. We assessed the early angiographic and long-term clinical and functional outcomes of patients with poor left ventricular function who underwent isolated CABG.
Methods:
We retrospectively reviewed the records of 78 patients with a poor left ventricular ejection fraction (35% or less) who underwent isolated CABG between January 1991 and November 2006. The mean age of the patients was 66.1+/-9.4 years, and their mean New York Heart Association functional class was 3.1+/-0.8. Their mean end-diastolic left ventricular diameter was 57.4+/-8.1 mm, and their mean grade of mitral regurgitation was 0.7+/-1.0. Early postoperative angiograms were performed at 32.5+/-33.5 days after the operation. Interval echocardiographic data were analyzed, and the long-term survival rate was evaluated.
Results:
The average number of distal anastomoses per patient was 3.2 +/-1.1. The operative mortality rate was 7.7%. Stroke occurred in 1.3% of patients. The overall patency rates for arterial and venous grafts were 100% and 97.2%, respectively. The left ventricular ejection fraction significantly improved from 28.2%+/-5.1% to 34.4%+/-8.4%. Both the end-diastolic and end-systolic left ventricular dimensions significantly decreased from 57.4+/-8.1 to 55.1+/-8.8 mm and from 47.4+/-8.4 to 45.1+/-9.7, re spectively. The actuarial patient survival rate at 10 years was 73.1%.
Conclusion:
CABG in patients with left ventricular dysfunction was effective, with favorable early graft patency rates. The long-term outcome was also acceptable, with echocardiographic functional recovery.
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