Coronary artery bypass grafting in patients with an ejection fraction of twenty percent or less.
Over a 7-year period, 5.8% (n = 210) of patients who underwent coronary artery bypass grafting at our institution had severely impaired global left ventricular function with an ejection fraction of 20% or less. Mean age at operation was 66 years (+/- 0.7; standard error), and 76% of patients were male. Primary indications for operation were unstable angina (73 patients, 35%), return of symptoms with previous bypass grafting (41 patients, 20%), congestive heart failure with reversible ischemia (55 patients, 26%), and recurrent ventricular arrhythmias (41 patients, 20%). Overall, actuarial survival (n = 210) was 82%, 79%, and 73% at 1, 2, and 5 years. Risk of death was highest early after the operation, and then declined rapidly to a constant level. Patients who did not receive retrograde coronary sinus cardioplegia (p = 0.05), older patients (p = 0.004), and those with preoperative ventricular arrhythmias (p = 0.003) or renal failure (p < 0.0001) had an increased risk of death early after operation. Patients with congestive symptoms and those requiring extensive or redo bypass grafting (p = 0.02) were found to be at an increased risk of death throughout the follow-up period. When the number of distal anastomoses performed increased, survival was found to decrease (p < 0.003), and to a greater extent in women than in men (p = 0.02). Of the four primary indications for operation, unstable angina yielded the highest risk-adjusted survival. Successful results after surgical revascularization in patients with severe impairment of ventricular function can be achieved by careful patient selection and management.
Kaul
T K
TK
Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, AL 35211, USA.
Agnihotri
A K
AK
Fields
B L
BL
Riggins
L S
LS
Wyatt
D A
DA
Jones
C R
CR
D000368:Aged; D000789:Angina, Unstable / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000601:surgery; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000601:surgery; D006801:Humans; D008297:Male; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome