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Coronary artery bypass surgery in patients with severe left-ventricular dysfunction
P S Olsen1, E Kassis, U Niebuhr-Jørgensen
1Department of Cardiothoracic Surgery, Gentofte Hospital, Hellerup, Denmark.
Insights
Coronary artery bypass surgery significantly improves heart function and working capacity in patients with ischemic heart disease and reduced left-ventricular ejection fraction. This surgical intervention offers substantial symptomatic and functional benefits.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Patients with depressed left ventricular function due to ischemic heart disease often have limited treatment options.
- Significant stenoses in major coronary arteries necessitate interventions to restore myocardial perfusion.
- Pre-existing conditions like previous myocardial infarctions can further compromise cardiac function.
Purpose of the Study:
- To evaluate the efficacy of coronary arterial bypass surgery in patients with poor left-ventricular function.
- To assess the impact of bypass surgery on left-ventricular ejection fraction and patient's working capacity.
- To determine the perioperative mortality and long-term survival rates.
Main Methods:
- A cohort of 31 patients with ischemic heart disease and reduced left-ventricular ejection fraction (mean 20%) underwent coronary arterial bypass surgery.
- Patients had significant coronary artery stenoses and varying histories of myocardial infarction.
- Echocardiography was used for pre- and post-operative assessment of left-ventricular ejection fraction (LVEF).
Main Results:
- The perioperative mortality rate was 9.7%, with a 1-year survival rate of 90%.
- Postoperative median LVEF significantly increased from 20% to 35%.
- Working capacity improved in 71% of the patients following surgery.
Conclusions:
- Coronary arterial bypass surgery can lead to significant symptomatic and functional improvement in patients with ischemic heart disease and impaired left-ventricular function.
- The procedure is associated with acceptable perioperative risks and favorable long-term survival.
- Bypass surgery effectively addresses perfusion defects contributing to poor cardiac function.
Abstract:
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.