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Late results with concomitant coronary artery bypass grafting and ICD implantation
J H Lee1, A K Konstantakos, H K Murrell
1Division of Cardiothoracic Surgery, Case Western Reserve, University School of Medicine, University Hospitals of Cleveland, OH 44106, USA.
Insights
Long-term survival after coronary artery bypass grafting and defibrillator implantation is impacted by left ventricular function. While sudden cardiac death is reduced, heart failure remains a significant limitation, particularly in patients with impaired left ventricular ejection fraction.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Coronary artery disease (CAD) and lethal ventricular arrhythmias pose significant long-term survival challenges.
- Concomitant coronary artery bypass grafting (CABG) and implantable cardioverter-defibrillator (ICD) implantation is a strategy for select patients.
- The influence of left ventricular function on outcomes in these patients requires further investigation.
Purpose of the Study:
- To evaluate the impact of left ventricular function on long-term survival in patients undergoing combined CABG and ICD implantation.
- To assess the safety and efficacy of this combined surgical approach in patients with varying degrees of left ventricular dysfunction.
Main Methods:
- A retrospective study of 54 consecutive patients undergoing CABG and ICD implantation.
- Patients were divided into two groups based on left ventricular ejection fraction (LVEF): Group I (LVEF ≤ 35%) and Group II (LVEF > 35%).
- Survival rates and causes of death were analyzed during a mean follow-up period of 42.5 months.
Main Results:
- In-hospital mortality was low (3.7%), with both deaths occurring in Group I (poor LVEF).
- During follow-up, Group I experienced significantly higher mortality (28.6%) compared to Group II (5.3%) (p < 0.04).
- Heart failure was the predominant cause of death, particularly in patients with reduced LVEF.
Conclusions:
- Concomitant CABG and ICD implantation is feasible with acceptable in-hospital mortality, even in patients with poor left ventricular function.
- While ICDs effectively prevent sudden cardiac death, overall long-term survival is limited by refractory heart failure.
- Left ventricular dysfunction at the time of surgery is a critical factor influencing long-term prognosis in these patients.
Background:
To determine the influence of left ventricular function on the long-term survival of patients with coronary artery disease and lethal ventricular arrhythmias, who undergo concomitant coronary artery bypass grafting (CABG) and implantable cardiovertor defibrillator (ICD) implantation, we studied survival in 54 consecutive patients who underwent CABG and ICD implantation.
Methods:
Group I consisted of 35 patients with left ventricular ejection fraction (LVEF) < or = 35% (mean 25.3 +/- 5.6) and Group II consisted of 19 patients with LVEF > 35% (mean 47.5 +/- 6.6). The two groups were similar with regards to age, gender, clinical presentation, induced arrhythmias, and the number of grafts placed at the time of surgery.
Results:
Two in-hospital deaths (3.7%) occurred, both in Group I. During follow-up (42.5 +/- 21.8 months), there were 10 deaths in Group I (1 noncardiac, 1 sudden, and 8 heart failure), and 1 death in Group II (heart failure) (p < 0.04).
Conclusions:
Concomitant CABG and ICD implantation can be performed with an acceptable in-hospital mortality, even in patients with poor left ventricular function. Although freedom from sudden cardiac death remains excellent, overall long-term survival is limited by refractory heart failure, especially in those patients with left ventricular dysfunction at the time of surgery.