title: Impact of left ventricular dysfunction on early and late outcomes in patients undergoing concomitant aortic valve replacement and coronary artery bypass graft surgery.
abstract: BACKGROUND
  An increasing proportion of patients present for concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) with left ventricular (LV) dysfunction. The aim of this study was to evaluate the early outcomes and late survival of patients with different degrees of LV function undergoing concomitant AVR and CABG.
  
  
  METHODS
  Between June 2001 and December 2009, patients undergoing concomitant AVR-CABG were identified from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program. Demographic, operative data and post-operative outcomes were compared between patients with normal (> 60%), moderately impaired (30- -60%), and severely impaired (< 30%) estimated LV ejection fraction (LVEF). Independent risk factors for short- and long-term mortality were identified using binary logistic and Cox regression, respectively.
  
  
  RESULTS
  AVR-CABG was performed in 2,563 patients with a mean follow up of 36 months (range 0-106). 144 (5.6%) had severely impaired LVEF, 983 (38.3%) had moderately impaired LVEF while the remaining 1377 (53.7%) had normal LVEF. The 30-day mortality in patients with severely impaired, moderately impaired and normal LVEF was 9.0%, 4.3% and 2.9%, respectively. This was significant on univariate (p < 0.001) but not multivariate analysis (p = NS). Severely impaired, moderately impaired and normal LVEF patients experienced 5-year survivals of 63.7%, 77.1% and 82.5%, respectively. Severely impaired LVEF was an independent multivariable predictor of late mortality (HR 1.71; 95% CI 1.22-2.40; p = 0.002).
  
  
  CONCLUSIONS
  Patients with severely impaired LVEF experience worse outcomes. However, in the era of modern surgery, this alone should not predicate exclusion, given the established benefits of surgery in this high-risk group.
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. andrew.newcomb@svhm.org.au.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.forename: Ashvin
authors.initials: A
authors.lastname: Paramanathan
authors.forename: William Y
authors.initials: WY
authors.lastname: Shi
authors.forename: Diem T
authors.initials: DT
authors.lastname: Dinh
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
authors.forename: Gilbert C
authors.initials: GC
authors.lastname: Shardey
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Newcomb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001315:Australia; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left