title: Results and predictors of early and late outcome of coronary artery bypass grafting in patients with severely depressed left ventricular function.
abstract: BACKGROUND
  Coronary artery bypass grafting (CABG) is a well-accepted therapeutic approach in patients with symptomatic multivessel coronary artery disease and severely depressed left ventricular function. However, the potential impact of off-pump CABG in this group of patients remains unknown. In addition, there are only scarce data regarding long-term survival and its predictors in this patient population.
  
  
  METHODS
  We retrospectively analyzed prospectively collected data of 2,725 consecutive patients (mean age, 65 +/- 11 years; 843 (31%) female) undergoing CABG between January 1998 and December 2005 (ejection fraction [EF] < or = 0.30; n = 495, 18%). Outcome measures included hospital mortality, major complications, and long-term survival. Multivariate analysis was performed to identify predictors of hospital mortality and late survival. Subgroup analysis for patients with EF less than or equal to 0.30 undergoing conventional CABG (n = 424, 86%) versus off-pump CABG (n = 71, 14%) was performed.
  
  
  RESULTS
  Hospital mortality was 1.8% (EF < or = 0.30, 3.6%; EF > 0.30, 1.4%; p = 0.002). Off-pump CABG did not have an impact on operative mortality (on-pump, 4%; off-pump, 3%; p = 0.509). Ejection fraction of 0.30 or less was not an independent risk factor of hospital mortality but predicted respiratory failure (odds ratio [OR] = 2.3) and sepsis (OR, 1.4). Long-term survival was significantly decreased in patients with EF of 0.30 or less: 1-year and 5-year survival 88% +/- 1.5% and 75% +/- 2.2% versus 96% +/- 0.4% and 81% +/- 1.2%, respectively (p = 0.001). Reoperation (OR, 6.9), peripheral vascular disease (OR, 3.2), chronic obstructive pulmonary disease (OR, 3.0), congestive heart failure (OR, 2.7), and female sex (OR, 2.1) were independent predictors of long-term survival.
  
  
  CONCLUSIONS
  Excellent results after CABG can be expected in patients with EF of 0.30 or less, with minimal increase in mortality and acceptable postoperative morbidity. Long-term survival remains limited, but recent results are substantially better than historical reports. Careful preoperative patient selection and perioperative management are essential in these patients undergoing CABG.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029-1028, USA. farzan.filsoufi@mountsinai.org
authors.forename: Farzan
authors.initials: F
authors.lastname: Filsoufi
authors.forename: Parwis B
authors.initials: PB
authors.lastname: Rahmanian
authors.forename: Javier G
authors.initials: JG
authors.lastname: Castillo
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left