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Myocardial revascularization for severe left ventricular dysfunction. Factors influencing early and late survival
1Division of Cardiovascular Surgery, University Hospital of Mont Godinne (Catholic University of Louvain), Yvoir, Belgium.
Insights
Coronary bypass surgery outcomes in patients with severe left ventricular dysfunction are satisfactory if the myocardium is viable. Preoperative factors like obesity and intra-aortic balloon use impact operative mortality and long-term survival.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Severe left ventricular dysfunction (LVEF ≤ 0.35) presents challenges for coronary bypass surgery.
- Assessing outcomes in this high-risk group is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the results of coronary bypass surgery in patients with severe left ventricular dysfunction.
- To identify independent risk factors for operative mortality and cardiac-related death.
Main Methods:
- Retrospective analysis of 102 patients undergoing coronary bypass surgery with LVEF ≤ 0.35.
- Utilized Cox regression analysis to determine predictors of cardiac-related death.
Main Results:
- Obesity and preoperative intra-aortic balloon counterpulsation were independent risk factors for operative mortality.
- Preoperative intra-aortic balloon counterpulsation, advanced age, and obesity were significant predictors of cardiac-related death.
- In a subset without these risk factors, the 4-year cardiac-related death rate was 95.1%.
Conclusions:
- Coronary bypass surgery can yield satisfactory results in selected patients with severe left ventricular dysfunction.
- Myocardial viability, rather than fibrosis, is a key determinant of successful long-term outcomes.
- Careful patient selection considering risk factors is essential for optimizing surgical results.
Abstract:
The results of coronary bypass surgery have been assessed in 102 patients with severe left ventricular dysfunction who had a preoperative left ventricular ejection fraction of < or = 0.35 (mean (s.e.m.) 0.29 (0.01)). Independent risk factors influencing operative mortality were obesity (P = 0.0290) and the need for preoperative intra-aortic balloon counterpulsation (P = 0.0010). Cox regression analysis using as its end-point 'cardiac-related death' demonstrated three variables; the need for preoperative intra-aortic balloon counterpulsation (P < 0.001), advanced age (P = 0.011), and obesity (P = 0.36). In a subset of 43 patients who did not have these risk factors, the 4-year cardiac-related death rate was 95.1 (3.4)%. The operative mortality and long-term survival can be expected to be satisfactory in patients with severe left ventricular dysfunction, provided they have a viable myocardium rather than myocardial fibrosis.