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Published on: September 15, 2023
Long-term outcome of coronary artery bypass grafting in patients with left ventricular dysfunction
Paolo Nardi1, Antonio Pellegrino, Antonio Scafuri
1Department of Cardiac Surgery, Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy. pa.nardi@hotmail.it
Insights
Coronary artery bypass grafting (CABG) offers excellent long-term outcomes for patients with coronary artery disease and reduced left ventricular ejection fraction (LVEF). Achieving complete revascularization is key to improving survival and reducing myocardial infarction rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Heart Failure Management
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for multivessel coronary artery disease with left ventricular dysfunction.
- Evaluating long-term results in patients with a preoperative left ventricular ejection fraction (LVEF) of 0.35 or less is crucial.
Purpose of the Study:
- To assess the long-term efficacy and survival rates following CABG in patients with severely impaired left ventricular function (LVEF ≤ 0.35).
- To identify predictors of operative mortality and late adverse cardiac events in this high-risk patient cohort.
Main Methods:
- Analysis of data from 302 consecutive patients undergoing CABG with LVEF ≤ 0.35.
- Use of inotropic agents (epinephrine, enoximone) and vasopressors (norepinephrine) to support cardiac index.
- Application of mechanical circulatory support (intra-aortic balloon pump, left ventricular assist devices) for postoperative low output syndrome.
Main Results:
- Complete revascularization (98.7%) and use of internal thoracic artery (97.4%) were high.
- Operative mortality was 5.3%, predicted by emergency CABG, ventricular arrhythmias, and prior anterior myocardial infarction.
- Ten-year survival was 63%, with predictors of late mortality including ventricular arrhythmias, renal dysfunction, and diabetes.
- Significant LVEF improvement was observed post-CABG (0.43 vs. 0.28).
- Ten-year freedom from myocardial infarction was 87%.
Conclusions:
- CABG provides excellent long-term results for patients with LVEF ≤ 0.35.
- Complete revascularization and internal thoracic artery grafting are associated with reduced myocardial infarction.
- Management of arrhythmias, diabetes, and renal dysfunction is vital for improving long-term survival.
Background:
Coronary artery bypass grafting (CABG) is a well-accepted therapeutic strategy for patients with multivessel coronary artery disease and left ventricular dysfunction. The aim of the study was to evaluate long-term results after CABG in patients with preoperative left ventricular ejection fraction (LVEF) of 0.35 or less.
Methods:
Data from 302 consecutive patients (mean age, 62 +/- 8.7 years) with LVEF of 0.35 or less who had undergone CABG were analyzed. Epinephrine and enoximone with or without norepinephrine were used to increase cardiac index. Intra-aortic balloon pump or left ventricular assist devices, or both, were used in case of postoperative low output syndrome.
Results:
Complete revascularization was achieved in 298 of 302 patients (98.7%); internal thoracic artery was used in 294 (97.4%). Operative mortality was 5.3%; independent predictors of operative mortality were emergency CABG (p = 0.005), history of ventricular arrhythmias (p = 0.007), and previous anterior myocardial infarction (p = 0.05). At follow-up, all-cause mortality was 30.8%, and 10-year survival was 63% +/- 4%; independent predictors of late all-cause mortality were history of ventricular arrhythmias (p < 0.0001), chronic renal dysfunction (p = 0.0004), and diabetes mellitus (p = 0.04). Cardiac death was 20.4%, and 10-year freedom from cardiac death was 73% +/- 3.3%; independent predictors of cardiac death were history of ventricular arrhythmias (p = 0.004), chronic renal dysfunction (p = 0.03), and more than one previous anterior myocardial infarction (p = 0.004). At 80 +/- 44 months of follow-up, echocardiography showed significant LVEF improvement (0.43 +/- 0.09 versus 0.28 +/- 0.06, p < 0.0001). Ten-year freedom from myocardial infarction was 87% +/- 3%.
Conclusions:
Excellent long-term results after CABG can be expected for patients with LVEF of 0.35 or less. Complete revascularization and internal thoracic artery grafting are associated with high freedom from myocardial infarction. Careful treatment of arrhythmias, diabetes, and renal dysfunction is necessary to improve long-term survival.
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