Complete revascularization in patients with severe left ventricular dysfunction.
OBJECTIVE
This study evaluates whether patients with coronary artery disease and severely depressed left ventricular ejection fraction (LVEF) benefit from complete revascularization by multivessel coronary artery bypass.


METHODS
From April 1994 to May 2002, 42 patients who underwent coronary artery bypass grafting (CABG) at our institution had impaired left ventricular (LV) function [an ejection fraction (EF) of 30% or less]. The average preoperative LVEF was 23.8%. The mean number of grafts was 4.6. Complete revascularization by multivessel bypass grafting was the goal for all patients.


RESULTS
Thirty days mortality was 0 and hospital mortality was 2.4%. The mean graft patency rate for 35 (83%) patients at one month was 98.8%. The mean postoperative LVEF improved significantly, from 23.8% to 35.2% (p<0.05), and the New York Heart Association (NYHA) classification was improved in most patients. The Kaplan-Meier estimate of survival at 5 years was 83.1%, and that of the cardiac event-free rate at 5 years was 77.5%.


CONCLUSIONS
For patients with poor LV function, complete surgical revascularization by multivessel bypass grafting can be performed safely, with satisfactory hospital mortality and long-term results.
Department of Cardiovascular Surgery, Osaka City General Hospital, Miyakojimahondori, Osaka, Japan.
Hiroyuki
H
Nishi
Satoru
S
Miyamoto
Shuichiro
S
Takanashi
Hirokazu
H
Minamimura
Takumi
T
Ishikawa
Yoshihiro
Y
Shimizu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013318:Stroke Volume; D014654:Vascular Patency; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology