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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.
Cardiovascular Surgery (London, England)
|April 18, 1998
Summary
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.