Long-term survival and functional recovery after isolated coronary artery bypass grafting in patients with severe left ventricular dysfunction.
OBJECTIVE
Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction has been considered to be a challenging operation. We assessed the early angiographic and long-term clinical and functional outcomes of patients with poor left ventricular function who underwent isolated CABG.


METHODS
We retrospectively reviewed the records of 78 patients with a poor left ventricular ejection fraction (35% or less) who underwent isolated CABG between January 1991 and November 2006. The mean age of the patients was 66.1+/-9.4 years, and their mean New York Heart Association functional class was 3.1+/-0.8. Their mean end-diastolic left ventricular diameter was 57.4+/-8.1 mm, and their mean grade of mitral regurgitation was 0.7+/-1.0. Early postoperative angiograms were performed at 32.5+/-33.5 days after the operation. Interval echocardiographic data were analyzed, and the long-term survival rate was evaluated.


RESULTS
The average number of distal anastomoses per patient was 3.2 +/-1.1. The operative mortality rate was 7.7%. Stroke occurred in 1.3% of patients. The overall patency rates for arterial and venous grafts were 100% and 97.2%, respectively. The left ventricular ejection fraction significantly improved from 28.2%+/-5.1% to 34.4%+/-8.4%. Both the end-diastolic and end-systolic left ventricular dimensions significantly decreased from 57.4+/-8.1 to 55.1+/-8.8 mm and from 47.4+/-8.4 to 45.1+/-9.7, re spectively. The actuarial patient survival rate at 10 years was 73.1%.


CONCLUSIONS
CABG in patients with left ventricular dysfunction was effective, with favorable early graft patency rates. The long-term outcome was also acceptable, with echocardiographic functional recovery.
Fukui
Toshihiro
T
Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, and Kansai Rosai Hospital, Hyogo, Japan. tfukui-cvs@umin.ac.jp
Shibata
Toshihiko
T
Sasaki
Yasuyuki
Y
Hirai
Hidekazu
H
Motoki
Manabu
M
Takahashi
Yosuke
Y
Nakahira
Atsushi
A
Suehiro
Shigefumi
S
D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*