Coronary Artery Bypass Grafting in Patients with Advanced Left Ventricular Dysfunction: Excellent Early Outcome with
Mehrdad Salehi1, Alireza Bakhshandeh1, Mehrzad Rahmanian1
1Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Coronary artery bypass grafting (CABG) is a safe and effective treatment for patients with severe left ventricular dysfunction (LVD). This study found low mortality rates and improved cardiac function after CABG in this high-risk population.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Left Ventricular Dysfunction Management
Background:
- Increasing prevalence of patients with severe left ventricular dysfunction (LVD) undergoing coronary artery bypass grafting (CABG).
- Preoperative LVD is a known risk factor for mortality following revascularization procedures.
Purpose of the Study:
- To evaluate the early outcomes of patients with severe LVD who underwent CABG.
- To compare on-pump versus off-pump CABG in this patient cohort.
Main Methods:
- A consecutive series of 145 patients with ejection fraction ≤ 30% undergoing CABG (on-pump or off-pump) between December 2012 and November 2014.
- Primary endpoint was all-cause mortality; various preoperative, intraoperative, and postoperative variables were analyzed.
Main Results:
- Mean preoperative ejection fraction of 25.33% improved post-CABG (p < 0.001).
- In-hospital mortality was 2.1%. Off-pump CABG had higher operative mortality but lower morbidity compared to conventional CABG (p < 0.050).
- Significant improvement in mitral regurgitation observed post-CABG (p < 0.001).
Conclusions:
- CABG can be performed with low mortality in patients with severe LVD.
- CABG is a safe and effective therapy for patients with ischemic heart disease, low ejection fraction, and viable myocardium.
Background:
The prevalence of patients with severe left ventricular dysfunction (LVD) referred for coronary artery bypass grafting (CABG) is increasing. Preoperative LVD is an established risk factor for early and late mortality after revascularization. The aim of the present study was to assess the early outcome of patients with severe LVD undergoing CABG.
Methods:
Between December 2012 and November 2014, 145 consecutive patients with severely impaired LV function (ejection fraction ≤ 30%) undergoing either on-pump or off-pump CABG were enrolled. The primary end point was all-cause mortality. Different variables (preoperative, intraoperative, and postoperative) were evaluated and compared.
Results:
The mean age of the patients was 58.7 years (range, 34 to 87 years), and 82.8% of the patients were male. The mean preoperative LV ejection fraction was 25.33 ± 5.07% (10 to 30%), which improved to 26.67 ± 5.38% (10 to 40%) (p value < 0.001). An average of 3.85 coronary bypass grafts per patient was performed. Significant improvement in mitral regurgitation was also observed after CABG (p value < 0.001). Moreover, 120 patients underwent conventional CABG (82.8%) and 25 patients had off-pump CABG (17.2%). In-hospital mortality was 2.1% (3 patients). Patients who underwent off-pump CABG had higher operative mortality than did those undergoing conventional CABG despite a lower severity of coronary involvement and a significantly lower number of grafts (p value < 0.050). Conversely, morbidity was significantly higher in conventional CABG (p value < 0.050).
Conclusion:
CABG in patients with severe LVD can be performed with low mortality. CABG can be considered a safe and effective therapy for patients with a low ejection fraction who have ischemic heart disease and predominance of tissue viability.
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