Coronary artery bypass surgery in patients with severe left-ventricular dysfunction

In the period 1988-91 31 patients with depressed function of the left ventricle but without valvular disease or congestive heart failure underwent coronary arterial bypass surgery. The median number of previous infarctions was 1.7 (0-4). Four patients had no history of previous myocardial infarction. All patients had ischemic heart disease and significant stenoses of the circumflex artery, the left anterior descendent artery, or the right coronary artery. Preoperatively the mean left-ventricular ejection fraction (LVEF) was 20% (9-26) judged by echocardiography. The median number of peripheral anastomoses was 4.9 (2-7). The perioperative mortality was 9.7%. One year survival was 90%. Postoperatively the median LVEF increased to 35% (11-50). After surgery the working capacity increased in 71% of the patients. This study has demonstrated that coronary arterial bypass surgery in patients with ischemic heart disease and poor left-ventricular function caused mainly by perfusion defects may result in symptomatic and functional benefit.