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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Predicting outcome after myocardial revascularization in patients with left ventricular dysfunction
M De Carlo1, A Milano, G Borzoni
1Department of Cardiac Surgery, University of Pisa, Italy.
Insights
Coronary artery bypass grafting offers good outcomes for patients with left ventricular dysfunction, but those with severe ventricular dilatation and mitral regurgitation may benefit more from cardiac transplantation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Left ventricular dysfunction (LVD) poses challenges for coronary artery bypass grafting (CABG).
- Identifying risk factors is crucial for optimizing outcomes in these high-risk patients.
Purpose of the Study:
- To identify preoperative risk factors predicting outcomes after isolated CABG in patients with LVD (ejection fraction ≤ 30%).
Main Methods:
- Retrospective evaluation of 80 consecutive patients undergoing isolated CABG with LVD.
- Analysis of preoperative data, operative outcomes, and long-term survival (mean 15 months).
- Assessment of risk factors for hospital mortality and overall cardiac mortality.
Main Results:
- Hospital mortality was 6.3%. Significant risk factors for hospital death included NYHA class IV, ventricular arrhythmias, and elevated left ventricular end-diastolic volume index.
- Two-year survival was 82%, with freedom from cardiac death at 84%.
- Risk factors for cardiac mortality included mitral regurgitation and renal dysfunction. Functional status improved post-CABG.
Conclusions:
- CABG can be performed with acceptable risk and improved function in LVD patients.
- Extensive ventricular dilatation with mitral regurgitation predicts poorer outcomes, suggesting cardiac transplantation may be a better option.
- Risk stratification is essential for guiding treatment decisions in LVD patients undergoing CABG.
Abstract:
In order to identify the risk factors which could predict outcome after coronary artery bypass grafting in patients with left ventricular dysfunction, 80 consecutive patients with an ejection fraction < or = 30%, who underwent isolated coronary artery bypass grafting at the authors' centre between January 1994 and May 1996 were evaluated. Preoperatively, mean(s.d.) ejection fraction was 27.1(3.8)%, 56 patients (70%) had angina, and 56(70%) were in New York Heart Association (NYHA) functional class III or IV. There were five operative deaths, with a hospital mortality rate of 6.3%. Significant risk factors for hospital death were NYHA class IV, preoperative ventricular arrhythmias and left ventricular end-diastolic volume index > 110 ml/m2. At mean follow-up of 15(7) (range 6-30) months, there were six late deaths, five of which were from cardiac causes. Actuarial survival rate at 2 years was 82(5)% and freedom from cardiac death 84(5)%. Risk factors for overall mortality from cardiac causes were preoperative grade 2 mitral regurgitation, associated with left ventricular dilatation, and renal dysfunction (creatininaemia > or = 180 micromol/l). At follow-up, mean ejection fraction was 37.5(8.4)%, and the overall functional status had improved: 12 patients (18%) had angina and eight (12%) were in NYHA class III and IV. Myocardial revascularization in patients with left ventricular dysfunction can be performed with acceptably low operative risk, good survival rate at 2 years, and functional status improvement. Patients with extensive ventricular dilatation, associated with significant mitral regurgitation, have a lower life expectancy and less functional benefits from coronary artery bypass grafting. These patients are better treated by cardiac transplantation.
