Coronary bypass surgery for patients with chronic poor preoperative left ventricular function (EF<30%): 5-year follow-up.
BACKGROUND
Optimal therapy for patients with coronary artery disease and chronic poor left ventricular function, given the absence of randomized trials, is unclear. Although coronary surgery has been performed in such patients for 25 years, it is perceived as high risk and unproven long-term benefit, especially if thallium scanning fails to demonstrate large areas of viability. We report the results of coronary surgery in these patients.


METHODS
Retrospective analysis by a standardized patient questionnaire, of 107 such consecutive patients offered coronary surgery.


RESULTS
Mean follow-up was 3.3 years (range, 0.5-5.5); average patient age was 64.4+/-1 years. Preoperative thallium scans were performed solely on 31 patients with none or mild angina, of which 10 (32%) demonstrated large areas of viable myocardium. Perioperative mortality was 1.9%. On multivariate analysis, factors predictive of increased perioperative death were recent myocardial infarction (p<0.001) and nonelective surgery (p<0.001). Kaplan-Meier 5-year survival and freedom from major adverse cardiac events were 72.3 and 82.3%, respectively. In 21 patients, with preoperative nil-to-mild angina and nil-to-small areas of myocardial viability, thallium scanning failed to predict a successful outcome.


CONCLUSIONS
Offering coronary surgery to these patients irrespective of thallium testing is safe and effective in the medium term. Early surgery is recommended.
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Verdun Street, Perth, WA 6010, Australia.
Jeremy
J
Tan
Nand
N
Kejriwal
Arvind
A
Vasudevan
Peter L Santa
PL
Maria
John M
JM
Alvarez
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D001315:Australia / Q000453:epidemiology; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data*; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013794:Thallium Radioisotopes; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*
D013794:Thallium Radioisotopes