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Coronary artery bypass grafting with or without surgical ventricular restoration: a comparison
Roni B Prucz1, Eric S Weiss, Nishant D Patel
1Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-4618, USA.
Insights
Surgical ventricular restoration (SVR) with coronary artery bypass grafting (CABG) improves outcomes for patients with enlarged ventricles and ischemic cardiomyopathy, reducing heart failure rehospitalizations and enhancing functional class, without impacting early survival.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Heart Failure Management
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for ischemic cardiomyopathy.
- Patients with ventricular enlargement undergoing CABG often experience poorer outcomes.
- Surgical ventricular restoration (SVR) aims to improve ventricular function in these patients.
Purpose of the Study:
- To evaluate the effectiveness of SVR combined with CABG (SVR + CABG) compared to CABG alone.
- To assess the impact on survival, heart failure rehospitalization, and functional status.
- To determine optimal treatment for ischemic cardiomyopathy with ventricular enlargement.
Main Methods:
- A case-control study compared 62 patients receiving SVR + CABG with 58 patients receiving CABG alone.
- Patients had ischemic cardiomyopathy and ejection fraction < 0.35.
- Outcomes measured included survival, rehospitalization for heart failure, and New York Heart Association (NYHA) class.
Main Results:
- SVR + CABG patients had significantly fewer heart failure rehospitalizations (24% vs. 55%) and improved NYHA class (80% vs. 57% improved to Class I/II).
- Operative mortality was similar (6.4% vs. 5.2%).
- Ejection fraction and 4-year survival rates were comparable between groups.
Conclusions:
- SVR + CABG offers comparable early survival to CABG alone for patients with ischemic cardiomyopathy and ventricular enlargement.
- SVR + CABG significantly reduces heart failure rehospitalizations and improves functional capacity.
- SVR + CABG should be considered for eligible patients with ischemic cardiomyopathy and ventricular enlargement.
Background:
Coronary artery bypass grafting (CABG) is an effective treatment for ischemic cardiomyopathy. However, patients with ventricular enlargement are known to have inferior outcomes. We assessed whether surgical ventricular restoration (SVR) with CABG (SVR + CABG) leads to improved outcomes versus CABG alone for patients with ischemic cardiomyopathy and ventricular enlargement.
Methods:
We conducted a case-control study comparing patients with ischemic cardiomyopathy and ejection fraction less than 0.35 who underwent SVR + CABG versus CABG alone from June 2002 to December 2005. Patients who underwent SVR + CABG were compared with control patients who met criteria for SVR + CABG by ventriculogram or echocardiogram but received CABG alone. End points included survival, rehospitalization for heart failure, and New York Heart Association class.
Results:
During the study period 120 patients underwent SVR + CABG (n = 62) versus CABG alone (n = 58). Patients in the SVR + CABG group were younger (60 versus 64 years; p = 0.04) and more likely to be New York Heart Association class III or IV preoperatively (98% versus 86%; p = 0.01). Operative mortality was similar between groups (6.4% versus 5.2%; p = 1.00). Ejection fraction was similar preoperatively (0.22 versus 0.24; p = 0.31) and postoperatively (0.34 versus 00.32; p = 0.40). The SVR + CABG patients experienced fewer rehospitalizations for heart failure (24% [13 of 54] versus 55% [24 of 44]; p = 0.006) but had similar 4-year survival (p = 0.60). At follow-up, 80% (50 of 62) of SVR + CABG versus 57% (27 of 47) of CABG alone patients improved to New York Heart Association class I or II (p = 0.01).
Conclusions:
Patients with ischemic cardiomyopathy and ventricular enlargement experience similar early survival after SVR + CABG or CABG alone. However, SVR + CABG resulted in fewer rehospitalizations and better improvements in New York Heart Association class. Surgical ventricular restoration with CABG should be offered to eligible patients with ischemic cardiomyopathy and ventricular enlargement.
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