Myocardial revascularization for severe left ventricular dysfunction. Factors influencing early and late survival.
The results of coronary bypass surgery have been assessed in 102 patients with severe left ventricular dysfunction who had a preoperative left ventricular ejection fraction of < or = 0.35 (mean (s.e.m.) 0.29 (0.01)). Independent risk factors influencing operative mortality were obesity (P = 0.0290) and the need for preoperative intra-aortic balloon counterpulsation (P = 0.0010). Cox regression analysis using as its end-point 'cardiac-related death' demonstrated three variables; the need for preoperative intra-aortic balloon counterpulsation (P < 0.001), advanced age (P = 0.011), and obesity (P = 0.36). In a subset of 43 patients who did not have these risk factors, the 4-year cardiac-related death rate was 95.1 (3.4)%. The operative mortality and long-term survival can be expected to be satisfactory in patients with severe left ventricular dysfunction, provided they have a viable myocardium rather than myocardial fibrosis.
Division of Cardiovascular Surgery, University Hospital of Mont Godinne (Catholic University of Louvain), Yvoir, Belgium.
Y
Y
Louagie
J
J
Jamart
M
M
Buche
P
P
Eucher
J P
JP
Haxhe
R
R
Lhommel
D
D
Schoevaerdts
M
M
Gonzalez
B
B
Marchandise
J C
JC
Schoevaerdts
D000368:Aged; D000787:Angina Pectoris / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology