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[CABG in 2 patients with severe left ventricular dysfunction]
A Yamaguchi1, A Mizuhara, H Ide
1Department of Cardiovascular Surgery, Jichi Medical School, Omiya Medical Center.
Insights
Coronary artery bypass grafting (CABG) can be considered for patients with severe left ventricular dysfunction (EF 16%) experiencing rest chest pain and myocardial ischemia. While one patient improved, another unfortunately died from multiple organ failure post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Severe left ventricular dysfunction (ejection fraction 16%) poses significant risks for cardiac surgical procedures.
- Patients with ischemic cardiomyopathy and refractory angina despite medical management require consideration for revascularization.
Observation:
- Two patients with ejection fraction of 16% underwent coronary artery bypass grafting due to rest chest pain and SPECT-confirmed myocardial ischemia.
- Surgical candidacy was pursued irrespective of the severely impaired left ventricular function.
Findings:
- The postoperative course was complicated in both patients.
- One patient experienced significant improvement, remaining asymptomatic from chest pain post-discharge.
- The second patient unfortunately succumbed to multiple organ failure.
Implications:
- Coronary artery bypass grafting may be a viable option for select patients with extremely low ejection fraction and active ischemia.
- Careful patient selection and management are crucial given the high-risk nature of such interventions.
- Outcomes can be variable, highlighting the need for further research into risk stratification and optimization strategies for this patient cohort.
Abstract:
Coronary artery bypass grafting was performed in two patients with left ventricular dysfunction (EF 16%). In both cases they had chest pain at rest and ischemic myocardium were detected by the SPECT. We considered them candidate for the operation regardless of LV dysfunction. They were eventful in the postoperative course. One case was discharged and is free from chest pain now, but another unfortunately died for multiple organ failure.