Comparison of complete and incomplete revascularization in CABG-patients with severely impaired left ventricular function (LVF).
OBJECTIVE
CABG-procedures in patients with depressed LV-ejection fraction (LVEF) may still cause complications. In patients with severely impaired LVEF, it is particularly unclear whether a complete revascularization (CR) leads to a better outcome than the possible advantage of a short period of ischemia. This may be reached by a possibly incomplete revascularization (ICR).


METHODS
In our department, 263 patients with LVEF < 30% underwent a CABG-procedure between 1996 and 2000. Patients were divided into two groups with regard to their revascularization: group A patients (n = 158) received all grafts that were thought to be necessary according to preoperative angiography, whereas in group B (n = 105) at least one graft could not be realized.


RESULTS
Mean number of grafts per patient was 3.59 +/- 0.58 in group A and 2.92 +/- 0.47 in group B (p < 0.05). Intraoperatively, 33% of group A patients needed catecholamines, compared to 48% in group B (p < 0.05). IABP was used more often in group B (n = 7 compared to n = 3 in group A) (p < 0.05). Postoperatively, there were also significant differences: duration of mechanical ventilation (A: 12.1 +/- 3.4 h; B: 20 +/- 5.2 h) (p < 0.05) and stay on ICU (A: 3.0 +/- 0.6 days; B: 4.2 +/- 0.6 days) (p < 0.05) were significantly prolonged in group B patients. Six patients from group B died during hospitalization (6%), compared to five from group A (3.2%) (p < 0.05).


CONCLUSIONS
In patients with a severely depressed LVEF, complete revascularization improves the outcome after CABG-procedures. A prolonged time of intraoperative ischemia and CPB can be accepted to realize an effective revascularization.
Boeken
U
U
Department of Thoracic and Cardiovascular Surgery, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Feindt
P
P
Litmathe
J
J
Gams
E
E
D000368:Aged; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D002395:Catecholamines / Q000008:administration & dosage; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003422:Critical Care; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*
D002395:Catecholamines