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Coronary artery bypass grafting in patients with chronic congestive heart failure: a 10-year experience with 203
W A Anderson1, D A Ilkowski, V L Mahan
1Department of Surgery, Deborah Heart and Lung Center, Browns Mills, New Jersey 08015, USA.
Insights
Coronary artery bypass grafting improves symptoms in patients with chronic heart failure due to ischemic cardiomyopathy. The procedure offers acceptable mortality rates and enhanced long-term survival, especially with internal mammary artery grafts.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Chronic congestive heart failure (CHF) significantly impacts quality of life.
- Ischemic cardiomyopathy is a common cause of advanced CHF.
- Coronary artery bypass grafting (CABG) is a potential treatment for selected CHF patients.
Purpose of the Study:
- To evaluate the efficacy and outcomes of primary CABG in patients with CHF and no angina.
- To identify risk factors for mortality and predictors of survival in this patient cohort.
Main Methods:
- Retrospective analysis of 203 patients with CHF undergoing primary CABG between 1983 and 1992.
- Assessment of New York Heart Association (NYHA) functional class, thallium perfusion imaging, and graft utilization.
- Analysis of hospital mortality, actuarial survival, and functional class improvement.
Main Results:
- 92% of patients were NYHA functional class III or IV pre-CABG.
- Hospital mortality was 6.0%, with 5-year actuarial survival at 59%.
- 75% of survivors improved functional class by a mean of 1.6 classes; internal mammary artery use improved late survival (p=0.01).
Conclusions:
- CABG effectively ameliorates symptoms in patients with chronic ischemic cardiomyopathy and CHF.
- The procedure is associated with acceptable early and late mortality.
- Internal mammary artery grafting enhances long-term survival in this high-risk group.
Abstract:
From 1983 to 1992, 203 patients with chronic congestive heart failure and no angina underwent primary coronary artery bypass. This represented 3% of patients undergoing coronary artery bypass grafting. Ninety-two percent of the patients were in New York Heart Association (NYHA) functional class III or IV prior to undergoing coronary artery bypass grafting. Thallium perfusion imaging was performed in 21% of the patients, with a reversible defect present in 88%. An internal mammary artery graft was used in 70% of the patients. The hospital mortality was 6.0% and the actuarial survival at 5 years was 59%. An improvement in NYHA functional class occurred in 75% of the surviving patients with a mean improvement of 1.6 +/- 0.6 functional classes. Univariate analysis identified risk factors for hospital death as emergency operation, recent myocardial infarction (< 30 days), and the need for an intra-aortic balloon pump. A trend emerged for nonuse of an internal mammary artery to predict hospital death. A positive thallium perfusion scan was not a predictor of early or late survival, nor did it influence NYHA functional class. The use of the internal mammary artery significantly enhanced late survival (p = 0.01), however, did not affect the functional class of survivors. We conclude that coronary artery bypass grafting is effective in ameliorating symptoms of chronic congestive heart failure in patients suffering from chronic ischemic cardiomyopathy and can be performed with acceptable early and late mortality.