Coronary artery bypass grafting with or without surgical ventricular restoration: a comparison.
BACKGROUND
Coronary artery bypass grafting (CABG) is an effective treatment for ischemic cardiomyopathy. However, patients with ventricular enlargement are known to have inferior outcomes. We assessed whether surgical ventricular restoration (SVR) with CABG (SVR + CABG) leads to improved outcomes versus CABG alone for patients with ischemic cardiomyopathy and ventricular enlargement.


METHODS
We conducted a case-control study comparing patients with ischemic cardiomyopathy and ejection fraction less than 0.35 who underwent SVR + CABG versus CABG alone from June 2002 to December 2005. Patients who underwent SVR + CABG were compared with control patients who met criteria for SVR + CABG by ventriculogram or echocardiogram but received CABG alone. End points included survival, rehospitalization for heart failure, and New York Heart Association class.


RESULTS
During the study period 120 patients underwent SVR + CABG (n = 62) versus CABG alone (n = 58). Patients in the SVR + CABG group were younger (60 versus 64 years; p = 0.04) and more likely to be New York Heart Association class III or IV preoperatively (98% versus 86%; p = 0.01). Operative mortality was similar between groups (6.4% versus 5.2%; p = 1.00). Ejection fraction was similar preoperatively (0.22 versus 0.24; p = 0.31) and postoperatively (0.34 versus 00.32; p = 0.40). The SVR + CABG patients experienced fewer rehospitalizations for heart failure (24% [13 of 54] versus 55% [24 of 44]; p = 0.006) but had similar 4-year survival (p = 0.60). At follow-up, 80% (50 of 62) of SVR + CABG versus 57% (27 of 47) of CABG alone patients improved to New York Heart Association class I or II (p = 0.01).


CONCLUSIONS
Patients with ischemic cardiomyopathy and ventricular enlargement experience similar early survival after SVR + CABG or CABG alone. However, SVR + CABG resulted in fewer rehospitalizations and better improvements in New York Heart Association class. Surgical ventricular restoration with CABG should be offered to eligible patients with ischemic cardiomyopathy and ventricular enlargement.
Prucz
Roni B
RB
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-4618, USA.
Weiss
Eric S
ES
Patel
Nishant D
ND
Nwakanma
Lois U
LU
Baumgartner
William A
WA
Conte
John V
JV
D000367:Age Factors; D006332:Cardiomegaly / Q000601:surgery; D009202:Cardiomyopathies / Q000150:complications / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006352:Heart Ventricles / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume