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[Long-term outcome of surgical revascularization in patients with ischemic heart disease and left ventricular

R Wang¹, C Q Gao, C S Xiao

¹Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing 100853, China.

Zhonghua Yi Xue Za Zhi

|April 28, 2016

Insights

Surgical revascularization for ischemic heart disease with left ventricular dysfunction shows improved long-term survival, but lower ejection fraction and intra-aortic balloon pump use are risk factors. Severe left ventricular dysfunction significantly impacts survival rates.

Area of Science:

Cardiology
Cardiac Surgery
Vascular Surgery

Background:

Ischemic heart disease (IHD) with left ventricular dysfunction (LVD) presents complex challenges for surgical revascularization.
Left ventricular ejection fraction (LVEF) is a critical indicator of cardiac function and prognosis in IHD patients.

Purpose of the Study:

To analyze the long-term outcomes and identify risk factors associated with surgical revascularization in patients suffering from IHD and LVD.
To evaluate the impact of preoperative LVEF and perioperative interventions on survival rates.

Main Methods:

A retrospective analysis of 318 patients with LVD (LVEF ≤50%) who underwent coronary artery bypass grafting (CABG) between January 2003 and July 2013.
Patients were categorized based on LVEF severity and surgical approach (off-pump vs. conventional).
Cox hazard ratio models were employed to analyze risk factors and long-term survival data.

Main Results:

Hospital mortality was 1.9%. The 5-year survival rate was 85.6%.
Lower preoperative LVEF (HR=0.943, P=0.031) and perioperative intra-aortic balloon pump (IABP) use (HR=2.509, P=0.038) were significant risk factors for all-cause mortality.
Patients with severe LVD (LVEF ≤35%) had a significantly lower 5-year survival rate (70.4%) compared to those with mild to moderate LVD (86.1%, P=0.025).

Conclusions:

Preoperative LVEF and perioperative IABP implantation adversely affect long-term survival in IHD patients with LVD undergoing surgical revascularization.
Severe LVD is associated with significantly poorer long-term survival outcomes.
Perioperative IABP use is linked to a significant decrease in long-term survival.

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Abstract

Objective:

To analyze the long-term results and risk factors of surgical revascularization in patients with ischemic heart disease (IHD) and left ventricular dysfunction (LVD).

Methods:

From January 2003 to July 2013, 2 132 patients underwent coronary artery bypass grafting (CABG) in our institution. Among them, 318 patients with LVD[left ventricular ejection fraction (LVEF) ≤50%]were included in the final study. There were 26 6 male and 52 female patients with age from 36 to 83 (63±9) years old. 76 patients underwent off-pump CABG (OPCAB) and 242 patients underwent conventional CABG (CCABG). Risk factors, perioperative results and follow-up data were collected and analyzed with cox hazard ratio model.

Results:

Among 318 patients, 6 cases died of the operation with a hospital mortality of 1.9%. With follow-up time from 1 to 128(45.5±32.4)months, 25 patients were lost of follow-up, causing a follow-up rate of 92.0%. Among the 287 cases with long-term follow-up results, all-cause death, cardiogenic death and re-hospitalization due to heart failure were 14.6% (42/287), 5.9%(17/287), 14.6% (42/287), respectively. Re-revascularization rate, recurrent angina and myocardial infarction rate and cerebral incidence were 3.5%(10/287), 13.6% (39/287), 1.7%(5/287), respectively. The five-year survival rate was 85.6%. With all-cause death as the endpoint, preoperative LVEF (HR=0.943, 95%CI: 0.893-0.995, P=0.031) and perioperative implantation of IABP (HR=2.509, 95%CI: 1.051-5.992, P=0.038) emerged as the risk factors that affected the long term survival. The five-year survival rate of patients with severe LVD (LVEF≤35%) was significantly lower than that of patients with mild to moderate LVD (35%

Conclusions:

Preoperative LVEF and perioperative implantation of IABP had adverse effect on long-term survival of patients with IHD and LVD undergoing surgical revascularization. The long-term survival of patients with severe LVD was significantly lower than those with mild to moderate LVD. The long-term survival significantly decreased among patients undergoing peri-operative implantation of IABP.

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