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Published on: November 28, 2018
Impact of preoperative positron emission tomography in patients with severely impaired LV-function undergoing
Johannes Boehm1, Felix Haas, Robert Bauernschmitt
1Klinik fuer Herz- und Gefaesschirurgie, Deutsches Herzzentrum Muenchen, Technische Universitaet Muenchen, Lazarettstrasse 36, 80636, Munich, Germany. johannesfboehm@googlemail.com
Insights
Positron emission tomography (PET) imaging improves survival for ischemic cardiomyopathy patients undergoing coronary artery bypass grafting (CABG). PET-assisted selection identifies patients most likely to benefit from CABG surgery, reducing perioperative mortality.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a key treatment for ischemic cardiomyopathy but has high mortality.
- The role of myocardial viability assessment in selecting patients for CABG remains undefined.
Purpose of the Study:
- To evaluate if Positron Emission Tomography (PET) imaging in decision-making improves postoperative survival in ischemic cardiomyopathy patients.
- To determine if preoperative myocardial viability assessment via PET identifies patients who benefit most from CABG.
Main Methods:
- Retrospective review of 476 ischemic cardiomyopathy patients (LVEF ≤0.35) considered for CABG.
- Comparison of a Standard Care Group (298 patients) with a PET-assisted management group (178 patients).
- PET-CABG group had 152 patients undergo surgery; 26 were excluded due to lack of viability.
Main Results:
- In-hospital mortality was significantly lower in the PET-assisted group (1.3%) compared to Standard Care (10.1%).
- Long-term survival rates at 1, 5, and 9.3 years were higher in the PET-assisted group (92.0%, 73.3%, 54.2%) versus Standard Care (88.9%, 62.2%, 35.5%).
- PET viability assessment, LV function, and age >70 significantly influenced long-term survival.
Conclusions:
- Preoperative myocardial viability assessment using PET identifies patients who will benefit most from CABG.
- PET-assisted management significantly improves postoperative survival in patients with ischemic cardiomyopathy undergoing CABG.
- Viability assessment is crucial for optimizing patient selection and outcomes in CABG surgery for ischemic cardiomyopathy.
Abstract:
In patients with ischemic cardiomyopathy, coronary artery bypass grafting (CABG) offers an important therapeutic option but is still associated with high perioperative mortality. Although previous studies suggest a benefit from revascularization for patients with defined viability by a non-invasive technique, the role of viability assessment to determine suitability for revascularization in patients with ischemic cardiomyopathy has not yet been defined. This study evaluates the hypothesis that the use of PET imaging in the decision-making process for CABG will improve postoperative patient survival. We reviewed 476 patients with ischemic cardiomyopathy (LV ejection fraction
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