Coronary artery bypass in patients with severely depressed ventricular function

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Medical Therapy Comparison

Background:

• Coronary artery disease (CAD) with severely depressed left ventricular ejection fraction (LVEF) presents a significant therapeutic challenge.
• Optimal management strategies for these high-risk patients remain a subject of ongoing research and clinical debate.

Purpose of the Study:

• To evaluate the efficacy and outcomes of isolated coronary artery bypass grafting (CABG) in patients with CAD and severely depressed LVEF (≤0.25).
• To identify preoperative factors associated with increased mortality and prolonged hospitalization after CABG in this patient cohort.

Main Methods:

• Retrospective analysis of 118 consecutive patients who underwent isolated CABG for CAD with LVEF ≤0.25 between 1981 and 1991.
• Kaplan-Meier survival analysis and univariate/multivariate Cox regression models were used to assess survival and factors influencing outcomes.

Main Results:

• Operative mortality was 11%, with ventricular arrhythmia and low cardiac output state as common complications.
• Five-year survival was 57.5%, exceeding estimated survival with medical therapy alone.
• Survivors showed significant improvements in angina class, congestive heart failure class, and ejection fraction.
• Preoperative factors associated with higher mortality included other vascular disease, female sex, hypertension, elevated left ventricular end-diastolic pressure, and depressed cardiac index.
• Prolonged cardiopulmonary bypass time, acute presentation, and female sex were linked to longer hospitalizations.

Conclusions:

• Coronary artery bypass grafting provides significant survival and symptomatic benefits for patients with coronary artery disease and severely depressed ejection fraction.
• Identification of specific preoperative risk factors can aid in tailoring treatment strategies and managing patient expectations.