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[Long survival (an average of 7 years) after coronary bypass in patients with severe left ventricular dysfunction]
O Jegaden1, A Eker, G D de Gevigney
1Service de chirurgie cardiaque et vasculaire, hôpital cardiologique Louis-Pradel, Lyon.
Insights
This study compared two myocardial revascularization techniques in patients with reduced ejection fraction. The newer technique, utilizing sequential venous bypass grafts, demonstrated improved early survival and reduced postoperative mortality.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Revascularization
Context:
- Patients with left ventricular ejection fraction < 40% and global hypokinesis were studied.
- Two surgical techniques were employed between 1970 and 1990.
- Symptoms included severe angina (Class III/IV) and dyspnea (Class II/III).
Purpose:
- To compare the efficacy and outcomes of two myocardial revascularization techniques.
- To evaluate early postoperative mortality and long-term survival rates.
- To assess the impact of surgical technique on patient survival in reduced ejection fraction patients.
Summary:
- Group I (1970-1981) used intermittent aortic clamping with internal mammary artery and simple venous grafts (avg. 1.6 grafts).
- Group II (1982-1990) used oxygenated cardioplegia with internal mammary artery and sequential venous grafts (avg. 3.7 grafts).
- Group II showed significantly lower early mortality (2.6% vs 7.6%) and improved 5-year survival (88% vs 71%) compared to Group I.
Impact:
- The study highlights the benefits of advanced surgical techniques in improving survival for patients with compromised left ventricular function.
- Findings suggest a shift towards more comprehensive revascularization strategies for better long-term cardiac outcomes.
- This research provides valuable data for clinical decision-making in the surgical management of ischemic cardiomyopathy.
Abstract:
The inclusion criteria of this study were a left ventricular ejection fraction of less than 40% with global left ventricular hypokinesis; left ventricular aneurysms and valvular lesions were excluded. From January 1970 to December 1990, 155 patients fulfilling these criteria had Class III or IV angina and 49 patients had Class II or III dyspnoea. The average left ventricular ejection fraction was 31 +/- 7%. Over this 20 year period two surgical techniques were used: Group I (79 patients operated between 1970 and 1981) myocardial revascularisation with intermittent aortic clamping by an internal mammary artery pedicle on the left anterior descending artery and simple venous bypass grafts; Group II (76 patients operated between 1982 and 1990) myocardial revascularisation under oxygenated cardioplegia by internal mammary artery pedicle on the left anterior descending artery associated with sequential venous bypass grafts. The average number of bypass grafts was 1.6 in Group I and 3.7 in Group II (p = 0.001). The early postoperative mortality (first month) was 5.2% it was lower in Group II (2.6%) than in Group I (7.6%) (p = 0.01). After 79 +/- 14 months follow-up, 6 patients were lost to follow-up, 51 patients had died secondarily and there were 90 survivors. Globally, 80% of deaths were of cardiac origin, 38% from cardiac failure. The actuarial 5, 10 and 15 year survival rates were 79 +/- 7%, 63 +/- 10% and 36 +/- 15% respectively. The 5 year survival in Group I was 71 +/- 10% compared with 88 +/- 8% in Group II (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)