Predictors of early outcome after coronary artery surgery in patients with severe left ventricular dysfunction.
BACKGROUND
The surgical survival in patients with severe myocardial dysfunction is critically dependent on the selection of patients. The present study was undertaken to identify the prognostic factors in such patients.


METHODS
We analyzed the data of 176 consecutive patients (161 men, 15 women), aged 29 to 88 years (mean 58.43), with a left ventricular ejection fraction (LVEF) < 30% who underwent isolated coronary artery bypass grafting. The LVEF ranged from 15% to 30% (mean 27.18%). Preoperatively, 33% had angina, 19.9% had recent myocardial infarction, and 21.6% had congestive heart failure. The mean number of grafts was 2.5/patient. The intra-aortic balloon was used prophylactically in 20.5% of patients and therapeutically in 4.0% of patients.


RESULTS
The hospital mortality was 2.3%. The complications occurred as follows: perioperative myocardial infarction in two (1.1%), intractable ventricular arrhythmias in two (1.1%), prolonged ventilation in four (2.3%) and peritoneal dialysis in 1 (0.6%). The mean ICU and hospital stay were 2.46 +/- 0.76 and 7.57 +/- 2.24 days, respectively. The predictors of survival on univariate analysis were New York Heart Association (NYHA) class (x2 = 14.458, p < 0.001), recent myocardial infarction (x2 = 5.852, p = 0.016), congestive heart failure (CHF) (x2 = 5.526, p = 0.019), and left ventricular end-systolic volume index (LVESVI) (x2 = 25.833, p < 0.001). However, on multivariate analysis, left ventricular end-systolic volume index was the only independent left ventricular function measurement predictive of survival (x2 = 10.228, p = 0.001).


CONCLUSIONS
Left ventricular end-systolic volume index is the most important predictor of survival after coronary artery bypass surgery in patients with severe myocardial dysfunction.
Trehan
Naresh
N
Escorts Heart Institute and Research Centre, Okhla Road, New Delhi 110025, India.
Khanna
Surendra Nath
SN
Mishra
Yugal
Y
Kohli
Vijay
V
Mehta
Yatin
Y
Mishra
Manisha
M
Mittal
Sanjay
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology*