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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.
Insights
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.
Abstract:
From January 1987 through June 1992, 18 patients with poor left ventricular function (left ventricular ejection fraction [LVEF] less than 0.3) underwent elective isolated primary coronary artery bypass surgery. The mean age was 56.4 years (range, 46 to 72 years), and 15 were males and 3 were females. Mean pre-operative LVEF measured by ventriculography was 0.26 +/- 0.03 (range, 0.19 to 0.30). Sixteen patients (88.9%) had a prior myocardial infarction and 9 (50%) had a history of congestive heart failure. Complete revascularization was the goal for all patients, and the mean number of bypass grafts was 3.0 +/- 0.8 per patient. The left anterior descending coronary artery (LAD) was revascularized in all patients. There were no operative deaths. Post-operative LVEF improved significantly from 0.26 +/- 0.03 to 0.42 +/- 0.11 (p = 0.0002), and the regional left ventricular wall motion improved in the diaphragmatic and posterobasal regions (p < 0.01). The patency of the grafts was 93.9% in all, and 100% for LAD. The mean follow-up period was 77 months, and the overall actuarial survival rate was 88.9% at 10 years. During follow-up periods, two patients died of congestive heart failure (CHF), and two required three rehospitalizations because of CHF. The overall cardiac event free rate was 75.8% at 10 years. In patients with poor left ventricular function, surgical revascularization can be performed safely, but congestive heart failure sometimes occurs during follow-up periods and may be the cause of death. Therefore alternate forms of therapy such as cardiac transplantation and/or TMLR should be considered in selected patients.