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[Coronary artery bypass grafting in cases with poor left ventricular function]
K Miyahara1, K Yasuura, Y Miyata
1Department of Thoracic Surjery, Nagoya University School of Medicine, Social Insurance Chukyo Hospital, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|January 13, 1999
Summary
Coronary artery bypass surgery safely improves heart function in patients with poor left ventricular ejection fraction. However, congestive heart failure remains a concern post-surgery, suggesting alternative therapies for select individuals.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Patients with severely impaired left ventricular function (LVEF < 0.3) present a high-risk group for cardiac surgery.
- Coronary artery disease (CAD) significantly impacts left ventricular function, leading to myocardial infarction and heart failure.
- Optimal surgical strategies for revascularization in this population remain a subject of investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of isolated primary coronary artery bypass (CABG) surgery in patients with poor left ventricular function.
- To assess the impact of CABG on left ventricular ejection fraction (LVEF) and regional wall motion.
- To determine long-term survival and cardiac event rates following CABG in this high-risk cohort.
Main Methods:
- Retrospective analysis of 18 patients with LVEF < 0.3 undergoing elective isolated primary CABG between January 1987 and June 1992.
- Pre- and post-operative LVEF assessment via ventriculography.
- Evaluation of graft patency, regional wall motion, operative mortality, and long-term survival.
- Follow-up for cardiac events, including rehospitalization for congestive heart failure (CHF).
Main Results:
- No operative deaths occurred. Post-operative LVEF significantly improved from 0.26 ± 0.03 to 0.42 ± 0.11 (p = 0.0002).
- Regional left ventricular wall motion improved in diaphragmatic and posterobasal areas (p < 0.01). Graft patency was 93.9% overall, and 100% for the left anterior descending artery (LAD).
- Ten-year actuarial survival was 88.9%. Two deaths were due to CHF, and two patients required rehospitalization for CHF. The 10-year cardiac event-free rate was 75.8%.
Conclusions:
- Elective isolated primary CABG can be safely performed in selected patients with poor left ventricular function, leading to significant functional improvement.
- Congestive heart failure remains a potential complication during follow-up and can be a cause of mortality.
- Cardiac transplantation and transmyocardial laser revascularization (TMLR) should be considered as alternative therapies for carefully selected patients.