Transplantation versus coronary artery bypass in patients with severe ventricular dysfunction. Surgical outcome and quality of life.
BACKGROUND
The purpose of this study is to evaluate the quality of life, functional status and survival rate of patients with left ventricular ejection fraction (LVEF) < or = 20% following coronary bypass (CABG) versus heart transplantation.


METHODS



METHODS
comparative study, mean follow-up of 20 months.


METHODS
division of cardiac surgery at a McGill University-based hospital in Montreal, Canada.


METHODS
the charts of 65 consecutive patients with angiographic LVEF < or = 20% were reviewed. Among these patients, 14/65 were referred for transplantation but instead underwent CABG (Group I) after consultation with the transplant committee. The charts of 14 matched transplant patients (Group II) were reviewed. The SF-36 and Duke's questionnaire forms were mailed to both groups in order to evaluate their quality of life and functional capacity, respectively.


METHODS
comparison between coronary bypass and heart transplantation.


METHODS
main outcome measures were mortality, quality of life, and functional capacity.


RESULTS
Results are expressed as mean+/-SEM. The in-hospital mortality rate of CABG among all patients with LVEF < or = 20% was 4.6% (3/65). Among the 14 CABG patients initially referred for transplantation, perioperative mortality was 1/14 (7.1%), same as in the matched transplant group. Three additional group I patients were reported by family to have died of cardiac events at follow-up period. Postoperative death identified at follow-up was assigned the lowest life quality score. The transformed quality of life scores were as follows: physical functioning: I=42.5+/-10.6, II=73.2+/-7.2, p=0.029; physical role: I=35.0+/-13.5, I=61.4+/-13.2, p=0.180; bodily pain: I=54.0+/-14.0, II=69.8+/-8.5, p=0.349; general health: I=34.7+/-9.2, II=84.6+/-5.2, p=0.0003; vitality: I=36.5+/-9.3, II=60.0+/-5.2, p=0.045; social functioning: I=55.0+/-4.0, II=87.5+/-5.1, p=0.050; emotional role: I=36.7+/-15.3, II=87.9+/-6.8, p=0.009; mental health: I=52.8+/-12.4, II=81.5+/-4.2, p=0.054. Duke's activity status index: I=16.8+/-4.2, II=31.8+/-4.2, p=0.021.


CONCLUSIONS
Heart transplant is associated with a significantly superior postoperative quality of life and functional capacity than bypass surgery. However, in patients with LVEF < or = 20%, CABG can be performed with an acceptable perioperative mortality of 4.6%-7.1%, similar to the rate for transplantation.
Shum-Tim
D
D
Department of Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada.
Pelletier
M P
MP
Latter
D A
DA
De Varennes
B E
BE
Morin
J E
JE
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000601:surgery*