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Myocardial revascularization for the patient with drastic impairment of function of the left ventricle

P Zubiate, J H Kay, A M Mendez

    The Journal of Thoracic and Cardiovascular Surgery
    |January 1, 1977
    PubMed

    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.

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