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Late survival up to 20 years after isolated coronary by-pass surgery using internal mammary artery in patients with
O Jegaden1, G de Gevigney, P Montagna
1Department of Cardiovascular Surgery, Hôpital Cardiologique, Lyon, France.
Insights
Coronary artery bypass surgery outcomes improved with a newer technique using sequential saphenous vein grafts and cardioplegic protection, showing lower early mortality and better 5-year survival rates for patients with reduced left ventricular ejection fraction.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Patients with coronary artery disease and reduced left ventricular ejection fraction (<40%) often present with severe symptoms like angina and dyspnea.
- Surgical revascularization is a key treatment, but outcomes can vary based on technique and myocardial protection strategies.
Purpose of the Study:
- To compare the early and late outcomes of two different coronary artery bypass grafting (CABG) techniques in patients with severely impaired left ventricular function.
- To evaluate the impact of surgical technique on mortality and survival rates in this high-risk patient population.
Main Methods:
- A retrospective study of 155 coronary patients with LVEF < 40% undergoing CABG between 1970 and 1990.
- Group I (n=79): Internal Mammary Artery (IMA) to Left Anterior Descending (LAD) + simple saphenous grafts, intermittent aortic cross-clamping.
- Group II (n=76): IMA to LAD + sequential saphenous grafts, oxygenated cardioplegic myocardial protection.
Main Results:
- Group II had a significantly lower early mortality rate (2.6% vs 7.6%, p=0.01) compared to Group I.
- The mean number of bypasses was higher in Group II (3.7 vs 1.6, p=0.001).
- Five-year actuarial survival rate was significantly better in Group II (88% ± 8%) than in Group I (71% ± 10%, p=0.02).
Conclusions:
- The surgical technique employing sequential saphenous vein grafts and cardioplegic myocardial protection (Group II) is associated with improved early mortality and long-term survival in coronary patients with reduced LVEF.
- These findings highlight the importance of advanced surgical techniques and myocardial protection strategies in managing complex coronary artery disease.
Abstract:
Coronary patients with left ventricular ejection fraction (LVEF) < 40% and abnormal motion of all left ventricular walls on cineangiography but without significant valve disease or left ventricular aneurysm were selected for this study. From January 1970 to December 1990, 155 patients meeting the above criteria consecutively underwent coronary by-pass surgery; preoperatively, 149 patients had angina class III or IV, and 49 patients had dyspnea class II or III. LVEF was 31 +/- 7%. During this 20-year period, two different surgical techniques have been used: from 1970 to 1981, 79 patients (group I) received internal mammary artery upon left anterior descending artery with associated simple saphenous grafts, under intermittent aortic cross clamping; from 1982 to 1990, 76 patients (group II) received internal mammary artery upon left anterior descending artery with associated sequential saphenous vein graft, under oxygenated cardioplegic myocardial protection. The mean number of by-pass was 1.6 in group I and 3.7 in group II (p = 0.001). Early mortality rate was lower in group II than in group I: 2.6% vs 7.6% (p = 0.01). After a follow-up of 79 +/- 14 months, there were 51 late deaths, 6 patients were lost to follow-up and 90 patients were still alive; 80% of all deaths were from cardiac causes, including 38% due to heart failure. Actuarial survival rate at 5, 10, 15 years was 79 +/- 7%, 63 +/- 10%, and 36 +/- 15% respectively. The 5-year survival rate was 71 +/- 10% in group I and 88 +/- 8% in group II (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)