title: Long-term survival and functional recovery after isolated coronary artery bypass grafting in patients with severe left ventricular dysfunction.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, and Kansai Rosai Hospital, Hyogo, Japan. tfukui-cvs@umin.ac.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hirai
authors.forename: Manabu
authors.initials: M
authors.lastname: Motoki
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakahira
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
mesh_terms: 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*