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[Myocardial revascularization in patients with severe ventricular impairment. Short-term follow-up]
Insights
Aortocoronary bypass grafting offers significant benefits for patients with impaired left ventricular function and severe angina. This surgery improves angina symptoms, quality of life, and cardiac function with acceptable surgical risk.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Cardiac Function Assessment
Context:
- Patients with severely impaired left ventricular (LV) function often present complex surgical challenges.
- Aortocoronary bypass grafting (CABG) is a standard treatment for coronary artery disease.
- The efficacy and safety of CABG in patients with markedly reduced LV ejection fraction (EF) require careful evaluation.
Purpose:
- To assess the surgical risk and short-term survival associated with CABG in patients exhibiting significant LV dysfunction.
- To evaluate the impact of CABG on angina symptoms, quality of life, exercise capacity, and LV function post-surgery.
Summary:
- A study of 22 patients with LV ejection fraction ≤0.35 undergoing CABG revealed a 4.5% operative mortality and 9.1% perioperative infarction rate.
- Follow-up showed an 81.8% survival rate at 10.5 months, with 94.5% of survivors asymptomatic from angina and improved exercise performance.
- Significant improvements in global and segmental LV function were observed post-CABG (mean EF increased from 0.27 to 0.37).
Impact:
- CABG demonstrates a relatively low surgical risk and encouraging short-term outcomes in carefully selected patients with severe LV dysfunction and refractory angina.
- The findings support CABG as a viable therapeutic option, improving clinical status and cardiac function in this high-risk patient group.
- This study highlights the potential for substantial quality of life improvements and functional recovery following CABG in patients with compromised left ventricular function.
Abstract:
To assess the influence of aorto-coronary bypass grafting on surgical risk and short-term survival of patients with marked impairment of left ventricular (LV) function, we evaluated--among 435 patients who underwent coronary bypass surgery between January 1981 and December 1982--22 cases with: LV ejection fraction (EF) less than or equal to 0.35 (mean 0.27 +/- 0.06), LV end-diastolic pressure greater than or equal to 15 mmHg (mean 19.9 +/- 6.9 mmHg.), presence of three or more dysfunctional (hypokinetic or akinetic) segments on biplane LV angiography, three vessels disease in 90.1%. All patients but two had angina refractory to medical therapy. Operative mortality rate was 4.5%. Perioperative non fatal infarction rate was 9.1%. There were three late deaths. Mean duration of follow-up was 10.5 +/- 8.3 months with a survival of 81.8%. In the survivors we observed: dramatic improvement in respect to angina (94.5% are asymptomatic) and quality of life; exercise performance improvement (75% of patients have a functional impairment less than or equal to 30% at treadmill test); significant improvement in global and segmental LV function (mean echocardiographic EF 0.37 +/- 0.10, p less than 0.001). Because of relative low surgical risk and encouraging short-term results, aortocoronary bypass grafting can be performed even in patients with important LV disfunction, when associated with severe angina.