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[Is the aorto-coronary bypass operation useful in patients with advanced coronary sclerosis and poor ventricular
Insights
Aortocoronary bypass surgery significantly improves survival and left ventricular function in patients with coronary artery disease and impaired heart function, offering better long-term results compared to medical treatment alone.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Clinical Outcomes
Context:
- Coronary artery disease (CAD) with impaired left ventricular function (ejection fraction ≤ 40%) presents a significant clinical challenge.
- Evaluating long-term outcomes is crucial for optimizing treatment strategies in these high-risk patients.
Purpose:
- To compare the long-term prognosis and clinical results of aortocoronary bypass surgery versus medical management in patients with CAD and severely reduced left ventricular ejection fraction.
- To assess the impact of surgery on survival rates, left ventricular function, and symptom severity.
Summary:
- A study compared 56 patients undergoing aortocoronary bypass surgery (with or without aneurysmectomy) to 47 medically treated patients with CAD and EF ≤ 40%.
- Surgical intervention resulted in significantly higher survival rates (80% vs. 58% at 41 months, p=0.012).
- Postoperative recatheterization showed improved left ventricular ejection fraction (33% to 44%, p<0.001) and reduced end-diastolic pressure (18 to 14 mmHg, p<0.025), alongside decreased angina and improved functional capacity (NYHA class improved from 2.9 to 2.1, p<0.001).
Impact:
- Aortocoronary bypass surgery demonstrates a clear benefit in improving survival for patients with severe CAD and compromised left ventricular function.
- Surgical treatment significantly enhances myocardial function and alleviates symptoms, leading to better quality of life.
- The findings support surgical revascularization as a superior therapeutic option for selected patients with coronary artery disease and impaired left ventricular function.
Abstract:
The prognosis and long term results in 56 patients with coronary artery disease and impaired left ventricular function (EF less than or equal to 40%) who underwent aortocoronary bypass surgery (all cases) and aneurysmectomy (26 cases) between 1972 and 1980 were compared with those in 47 equally ill patients treated medically. Survival was significantly higher in the surgical than in the non-surgical group, the survival rate being 80% and 58% respectively at 41 months after study entry (p = 0.012). No difference in survival was observed between grafted patients and patients in whom additional aneurysmectomy was performed. 26 patients were recatheterized postoperatively and this revealed an increase in left ventricular ejection fraction at rest from 33 +/- 5% to 44 +/- 11% (p less than 0.001) and a decrease in left ventricular end-diastolic pressure from 18 +/- 8 mm Hg to 14 +/- 8 mm Hg (p less than 0.025). Postoperatively the patients had less angina and physical working capacity increased. At restudy the average NYHA class had decreased in the surgical group from 2.9 +/- 0.7 to 2.1 +/- 0.9 (p less than 0.001) but was unchanged in the non-surgical group (2.6 +/- 0.6 and 2.6 +/- 0.7 respectively). It is concluded that aortocoronary bypass surgery improves survival, left ventricular function and symptoms in patients with coronary artery disease and severely impaired myocardial function.