The Long-term Results Of Cabg For Patients With Left Ventricular Dysfunction
Hiroshi Seki, Dai Une, Atsushi Kurata.
Yamato Seiwa Hospital, Yamato, Japan.
BACKGROUND: The cornerstone of treatment for patients with reduced left ventricular function and ischemic cardiomyopathy is guideline driven medical therapy for all patients and implantable device therapy for appropriately selected cases. The role of surgical revascularization in this highest-risk patients remains controversial due to the high perioperative risks and lack of proven benefits in the long-term The scope of this study is to assess the perioperative morbidity and mortality and the long-term results in this group of patients.
METHODS: The records of patients who underwent an isolated coronary artery bypass grafting surgery at our institute between 2008 and 2012 were reviewed. All patients with preoperative left ventricle dysfunction, ejection fraction (EF) under 40%, including emergency and urgent cases were included.
Mean age was 69.0±10.3 and the majority (86.7%) were male. Thirtythree patients (36.7%) had a history of congestistive heart failure. Twentythree patients (25.6%) had a history of prior PCI. Preoperative ejection fraction was in average 31.6± 6.2%.
9 (10%) patients were in cardiogenic shock. In 56 cases (62.2%) surgery was performed with the off-pump method. The mean number of distal anastomoses was 3.5±1.5. There were two (2.2%) 30-days hospital mortality. Freedom from all-cause death was 89.7%, and 80.4%, freedom from MACE (cardiac death, revascularization, myocardial infarction) was 91.8% and 76.5% after 1 year and 5 years, respectively. Average follow up time was 24.8 months (max 92.4 months).
Left ventricle function was assessed with measurement of transthoracal echocardiography. Ejection fraction was in average 32.0 ±6.3% preoperatively and improved in 67% cases. The ejection fraction measured in the last follow up was in average 42.1 ±10.3%. In ca. half of the cases, the improvement was over 10% in EF. This correlated with the use of Beta-Blocker (HR 3.3,p=0.01) and off-pump cases (HR 2.8,p=0.03 ).
CONCLUSIONS: Coronary artery bypass grafting can be performed safely in patients with left ventricular dysfunction with minimal postoperative morbidity and mortality. Postoperative optimal medical therapy and usage of off-pump technique may be benificial for this high-risk group of patients.
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