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Long-term results of coronary artery bypass grafting in patients with left ventricular dysfunction
Mohamed A Soliman Hamad1, M Erwin S H Tan, Albert H M van Straten
1Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands. aasmsn@cze.nl
Insights
Coronary artery bypass grafting offers good long-term outcomes for patients with reduced left ventricular ejection fraction. Preoperative left ventricular end-systolic volume index helps predict success.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Investigated long-term outcomes, symptoms, and left ventricular function after coronary artery bypass grafting (CABG).
- Focused on patients with moderate to severely decreased left ventricular ejection fraction.
Purpose of the Study:
- To determine predictors of long-term outcomes in patients undergoing CABG.
- To assess changes in symptoms and left ventricular function post-CABG.
Main Methods:
- Prospective study of 75 patients with moderate to severe left ventricular dysfunction undergoing CABG (1997-1998).
- Monitored 72 survivors for 8 years, assessing mortality, New York Heart Association (NYHA) functional class, and left ventricular function via echocardiography.
- Utilized multivariate analysis to identify preoperative indicators.
Main Results:
- 8-year survival rate was 89.3%.
- Left ventricular ejection fraction significantly improved post-CABG (0.322 to 0.463, p < 0.001).
- Left ventricular end-systolic volume index, angina, and absence of heart failure symptoms predicted freedom from heart failure post-CABG.
Conclusions:
- CABG provides acceptable long-term results for patients with moderate-to-severe left ventricular dysfunction.
- Left ventricular end-systolic volume index is a valuable preoperative predictor for decision-making in these patients.
Background:
In this prospective study, we investigated the determinants of long-term outcome, symptoms, and left ventricular function after coronary artery bypass grafting in patients with a moderate to severely decreased left ventricular ejection fraction.
Methods:
Between 1997 and 1998, 75 consecutive patients with moderate to severe left ventricular dysfunction underwent coronary artery bypass grafting procedures. The operative mortality rate was 4.0%, and the 72 survivors were monitored for 8 years. The end points were mortality, symptomatic status (New York Heart Association [NYHA] functional class), and left ventricular function.
Results:
The total survival rate after 8 years was 89.3%. During follow-up, 8 patients died. Death was attributed to a cardiac cause in 5 patients and to a noncardiac cause in 3. There was no statistically significant difference between preoperative and late postoperative NYHA functional class, despite a statistically significant improvement that persisted for up to 4 years after CABG. The results of echocardiography showed a statistically significant improvement in the left ventricular ejection fraction (from 0.322 +/- 0.06 preoperatively to 0.463 +/- 0.02 at follow-up, p < 0.001). Multivariate analysis revealed that the left ventricular end-systolic volume index, the presence of angina pectoris, and absence of symptoms of congestive heart failure were preoperative indicators of freedom from heart failure after coronary operations (p < 0.05).
Conclusions:
Coronary artery bypass grafting for patients with moderate-to-severe left ventricular dysfunction is associated with acceptable long-term results. The left ventricular end-systolic volume index is a simple noninvasive method to aid in the preoperative decision making in such patients.
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