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Myocardial revascularization for the patient with drastic impairment of function of the left ventricle
Insights
For patients with coronary artery disease and severely impaired left ventricular function, surgery significantly improves survival rates compared to medical treatment alone. Myocardial revascularization offers better long-term outcomes for these critically ill individuals.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Treatment Outcomes
Background:
- Patients with coronary artery disease and severely impaired left ventricular function (ejection fraction ≤ 0.2) historically have poor outcomes with medical management.
- Survival rates after 5 years for medically treated patients in this cohort were only 22%.
Purpose of the Study:
- To evaluate the efficacy of surgical myocardial revascularization in improving survival rates for patients with coronary artery disease and severely impaired left ventricular function.
- To compare the long-term outcomes of surgical intervention versus medical treatment in this high-risk patient population.
Main Methods:
- A cohort of 140 patients with an ejection fraction of 0.2 or less underwent myocardial revascularization.
- Survival data were analyzed using actuarial curves, comparing surgical outcomes to historical medical treatment data.
- Hospital mortality for the surgical group was recorded.
Main Results:
- The surgical group experienced 31 hospital deaths.
- Actuarial analysis showed a 59% survival rate at 6 years for surgically treated patients.
- This contrasts sharply with the 22% survival rate at 5 years for medically treated patients.
Conclusions:
- Myocardial revascularization surgery can significantly enhance survival for patients with drastic impairment of left ventricular function, provided the operative mortality rate is sufficiently low.
- Surgically treated patients demonstrated significant clinical improvement.
- Surgical intervention offers a superior outlook for critically ill patients with coronary artery disease and severely reduced ejection fraction.
Abstract:
The results with medical treatment of the patient with coronary artery disease and marked impairment of left ventricular function have been poor. Of 79 patients deemed operable with an ejection fraction of 0.2 or less, only 17 (22 per cent) were alive according to an acturial curve 5 years later. We believed that surgery might offer a better outlook for these critically ill patients. Therefore, since 1969, 140 patients with an injection fraction of 0.2 or less were treated by myocardial revascularization alone, with 31 hospital deaths. Actuarial curve reveals that at 6 years, 59 per cent of the surgically treated patients are alive, and only 22 per cent treated medically are alive at 5 years. It is concluded that if the operative mortality rate is low enough, surgery enhances the survival of patients who have drastic impairment of left ventricular function. These patients are significantly improved clinically.