Coronary artery bypass in patients with impaired left ventricular function.
Myocardial revascularisation in patients with severe left ventricular dysfunction has been shown to improve survival. This report analyses the efficacy of myocardial revascularisation in this subset of patients with coronary artery disease manifesting severe left ventricular dysfunction on the basis of left ventricular ejection fraction (LVEF). Twenty-two consecutive patients with coronary artery disease complicated by severe left ventricular dysfunction underwent aorta-coronary bypass electively at Singapore General Hospital for the 3 year period ending February 1989. Twenty-one patients have angina +/- congestive heart failure refractory to medical therapy. One patient had congestive heart failure and objective evidence of ischaemia confirmed by preoperative thallium stress test. Nineteen (82.6%) patients had triple-vessel coronary artery disease. The mean LVEF for the series was 25% with the range from 10-13%. The duration of follow up was 6 months to 3 years (mean 24 months) with follow up survival data on 100% of patients. The hospital mortality was 9% (2/22) and there were 3 late deaths. Of the 17 survivors available for direct assessment, 12 reported improvement in their symptoms and 3 are completely asymptomatic. These preliminary results indicate that myocardial revascularisation can be performed in patients with severe LV dysfunction at an acceptable risk and that operation results in improvement in survival expectation and symptoms compared with medical therapy.
Wong
J W
JW
Department of Cardiothoracic Surgery, Singapore General Hospital.
Tong
M C
MC
Ong
K K
KK
D000787:Angina Pectoris / Q000503:physiopathology / Q000601:surgery*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D015996:Survival Rate