[Influence of aorto-coronary bypass surgery on left ventricular function and prognosis in patients with severe left coronary artery disease]

The effects of aorto-coronary bypass surgery on left ventricular (LV) function and prognosis were studied in 21 patients with severe left coronary artery disease consisted of 8 left main trunk (LMT) stenosis and 17 left main equivalent (LME) that is the combined disease of left anterior descending (LAD) and left circumflex coronary arteries proximal to the origin of their major branches. One of 21 cases had bypass grafts occluded on the postoperative angiogram. The other 20 cases consisted of 10 cases with previous transmural myocardial infarction (PTMI) and 10 without PTMI had all bypass grafts opened including 20 grafts to LAD. In 10 cases without PTMI, all of LV function parameters markedly improved postoperatively. In the other 10 cases with PTMI, LV ejection fraction significantly increased from 0.53 +/- 0.07 preoperatively to 0.67 +/- 0.04 postoperatively (p less than 0.005). PLVSP/LVESV also increased from 1.85 +/- 0.66 to 2.89 +/- 1.16 (p less than 0.05). In both groups, LV segmental wall motion (SWM) increased in the anterior and apical segment, whereas did not in the postero-inferior segment. In the case with occluded grafts LV function was deteriorated postoperatively. Even in the cases which anterior SWM showed less than 30% (the lowest value in the normal subjects), anterior and apical SWM significantly increased postoperatively in both groups. Angina disappeared postoperatively in all cases but one with PTMI. All cases showed NYHA class III to IV preoperatively, then class I to II postoperatively. Postoperative 8 years actuarial survival rate was 91.0%.