Off-pump coronary artery bypass in severe left ventricular dysfunction.
The outcome of multivessel off-pump coronary artery bypass grafting in cases of severe left ventricular dysfunction was studied in 58 consecutive patients with ejection fraction < or =35% who were followed up for a median of 15 months. Patients with ejection fractions < or =25% (group 1) had the largest left ventricular dimensions preoperatively, with gradual increases during follow-up; those with ejection fractions of 26%-35% (group 2) had smaller preoperative ventricular dimensions, with left ventricular regression postoperatively. There was more improvement in ejection fraction in group 2 than group 1 (33% vs. 10%). Mitral regurgitation improved from moderate to mild in group 2; whereas in group 1, mild mitral regurgitation progressed to moderate or severe during follow-up. Ejection fraction was a predictor of more frequent use of intraaortic balloon pumping, longer duration of inotropic use, a higher mean pulmonary artery-to-systemic arterial pressure ratio, and increased postoperative drainage.
Pande
Shantanu
S
Department of Cardiovascular and Thoracic Surgery, Lucknow 226014, UP, India. spande@sgpgi.ac.in
Agarwal
Surendra K
SK
Kundu
Anirban
A
Kale
Niraj
N
Chaudhary
Amit
A
Dhir
Udgeath
U
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D047549:Coronary Artery Bypass, Off-Pump; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000601:surgery*