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Primary isolated coronary artery bypass in left ventricular dysfunction: survival and predictors of survival
Insights
Patients with reduced ejection fraction undergoing coronary artery bypass surgery had lower survival rates. Congestive heart failure significantly impacted outcomes, highlighting the importance of managing ventricular dysfunction in cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Reduced ejection fraction (EF) is a critical indicator of cardiac health.
- Coronary artery bypass grafting (CABG) is a common intervention for coronary artery disease.
- Ventricular dysfunction can significantly impact surgical outcomes.
Purpose of the Study:
- To evaluate the long-term survival rates of patients with varying degrees of ventricular dysfunction undergoing isolated CABG.
- To identify key factors influencing survival in this patient population.
Main Methods:
- Retrospective analysis of 462 patients with EF < 51% who underwent primary isolated CABG.
- Patients were stratified into two groups based on EF: severe dysfunction (EF < 30%) and moderate dysfunction (EF 31-50%).
- Actuarial survival and multivariate analysis were performed at a median follow-up of 5.8 years.
Main Results:
- Actuarial survival was significantly lower in the severe dysfunction group (64.3%) compared to the moderate dysfunction group (80.6%) (P = 0.0001).
- Congestive heart failure was the most significant predictor of mortality in both groups (P = 0.0001).
- Preoperative inotrope use in severe dysfunction (P = 0.03) and peripheral vascular disease in moderate dysfunction (P = 0.001) were also associated with reduced survival.
Conclusions:
- Severe ventricular dysfunction is associated with poorer long-term survival after isolated CABG.
- Effective management of congestive heart failure is paramount for improving survival in patients with reduced EF undergoing CABG.
- Comorbidities like peripheral vascular disease and the need for inotropic support are important considerations for risk stratification.
Abstract:
Coronary angiograms of 462 patients with ejection fractions below 51% who underwent primary isolated coronary artery bypass at the Cleveland Clinic from 1981 to 1985 were available for review. They were divided into two groups: group 1 (n = 166) with severe ventricular dysfunction (ejection fraction less than 30%) and group 2 (n = 296) with moderate ventricular dysfunction (ejection fraction 31 to 50%) at a median follow-up of 5.8 years/patient. The actuarial survival was 64.3% in group 1 and 80.6% in group 2 (P = 0.0001). By multivariate analysis, congestive heart failure (P = 0.0001) was the single most important factor affecting survival for both groups. In addition, in group 1 the preoperative use of inotropes (P = 0.03) and in group 2 the presence of peripheral vascular disease (P = 0.001) affected long term survival.