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Ischemic cardiomyopathy: medical versus surgical treatment
Insights
Aorta-coronary bypass grafting significantly improves survival and symptoms for patients with ischemic heart disease and reduced left ventricular ejection fraction (LVEF). Surgical intervention offers better outcomes than medical therapy alone.
Area of Science:
- Cardiology
- Cardiac Surgery
- Internal Medicine
Background:
- Ischemic heart disease with depressed left ventricular function has a poor prognosis.
- Medical therapy has historically failed to significantly alter the natural history of this condition.
- Left ventricular ejection fraction (LVEF) is a critical indicator of cardiac function.
Purpose of the Study:
- To evaluate the efficacy of aorta-coronary bypass grafting in patients with coronary artery disease and severely reduced LVEF (≤0.3).
- To compare outcomes between medically treated patients and those undergoing surgical revascularization.
- To assess survival rates, symptom relief, and operative mortality.
Main Methods:
- A comparative study involving 70 medically treated patients and 46 patients who underwent aorta-coronary bypass grafting.
- Patients had angina pectoris and reduced LVEF (mean LVEF 0.20-0.21).
- Follow-up ranged from 6 to 72 months (mean 19 months).
Main Results:
- The 2-year actuarial survival rate was 47% for the medical group versus 83% for the surgical group.
- Significant improvement in angina and/or congestive heart failure was observed in 95% of surgical patients compared to 16% of medical patients.
- Operative mortality in the surgical group was 4% (2/46), with four late deaths.
Conclusions:
- Aorta-coronary bypass grafting is a viable and effective treatment for patients with poor left ventricular function and coronary artery disease.
- Surgical revascularization offers improved survival, relief of angina pectoris, and amelioration of congestive heart failure symptoms.
- The procedure can be performed with a low operative mortality rate in this high-risk patient population.
Abstract:
The natural history of patients with ischemic heart disease and depressed left ventricular function is dismal, and medical therapy has failed to alter its course. To assess the results of aorta-coronary bypass grafting in patients with coronary artery disease and decreased left ventricular ejection fraction (LVEF less than or equal to 0.3), we compared 70 medically treated patients to 46 patients having aorta-coronary bypass grafting. The duration of follow-up was 6 to 72 months (mean 19 months). All patients had angina pectoris. Congestive heart failure was present in 56 percent (39/70) of the medical and 43 percent (20/46) of the surgical group. The medical group had a mean LVEF of 0.20 and a mean left ventricular end-diastolic pressure (LVEDP) of 29 mm. Hg. The surgical group had a mean LVEF of 0.21 and a mean LVEDP of 24 mm. Hg. Three vessel disease was found in 60 percent (42/70) of the medical group and 83 percent (38/46) of the surgical group. The operative mortality rate in the surgical group was 4 percent (2/46). There were four late deaths. The 2 year actuarial survival rate for medical and surgical groups was 47 percent and 83 percent, respectively. Significant improvement in angina pectoris and/or congestive heart failure was found in 16 percent (11/70) of medically treated patients and 95 percent (38/40) of the surgically treated patients. Aorta-coronary bypass grafting can be performed in patients with poor left ventricular function with a low operative mortality rate, relief of angina pectoris, and improvement in symptoms of congestive heart failure.