Predictors of outcome after coronary bypass surgery in patients with left ventricular dysfunction.
OBJECTIVE
The aim of this study was to determine the risk factors affecting the mortality and morbidity after coronary artery bypass grafting (CABG) in patients with LV dysfunction and without any viability assessment.


METHODS
The preoperative, perioperative, and postoperative early and mid-term follow-up data of 252 patients with left ventricular ejection fraction (LVEF) of < or = 30% who underwent isolated CABG from 1995 through 2000, were evaluated. No preoperative viability study was performed for patient selection. Preoperative echocardiography and cardiac catheterization, and postoperative control echocardiography were performed in all patients. Follow-up data after the discharge of these patients were obtained via monthly periodical examinations in the first 6 months, and thereafter via telephone interviews. As preoperatively, 229 (90.87%) patients were in NYHA class III or IV, and the mean LVEF was 26.58 +/- 3.66%.


RESULTS
Overall mortality and late mortality rates were 16.27% and 5.16%, respectively. Postoperative complications were observed in 61 (24.21%) patients. During 49.06 +/- 15.17 months of follow-up, 185 (93.43%) of 198 (78.57%) survived patients were in NYHA class I or II and the mean LVEF was 39.64% +/- 5.68%. Advanced age, diabetes, hypertension, cross-clamp time > 60 min, bypass time > 120 min, severity of angina and functional classes (class III-IV of NYHA and CCS) were found to be the determinants of mortality. However, by multivariate analysis only older age and class III-IV of NYHA and CCS were detected as predictors of mortality.


CONCLUSIONS
The low mortality and morbidity rates as well as postoperative improvements in functional capacity and in LVEF support the use of CABG without the need of any viability assessment in patients with left ventricular dysfunction. Advanced age, severe angina and functional symptom status seem to be the predictors of poor prognosis in these patients after CABG.
Islamoğlu
Fatih
F
Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir. fislamoglu@hotmail.com
Apaydin
Anil Ziya
AZ
Ozbaran
Mustafa
M
Yüksel
Münevver
M
Telli
Ali
A
Durmaz
Isa
I
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000401:mortality*; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000473:pathology / Q000601:surgery*