title: Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction.
abstract: Despite encouraging improvements, outcomes of coronary artery bypass grafting (CABG) in the presence of left ventricular (LV) dysfunction remain poor. In the present study, the authors' experience on this subject was reviewed to establish the predictors of immediate and long-term results of surgery. Out of 4383 consecutive patients with multivessel coronary artery disease who underwent primary isolated CABG at the authors' institution from January 1999 throughout September 2014, 300 patients (mean age 66.1 ± 9.6 years) suffered preoperatively from LV dysfunction (defined as LV ejection fraction ≤35 %). The mean expected operative risk (EuroSCORE II) was 10.3 ± 13 %. Hospital deaths and perioperative complications were analyzed retrospectively. Outcomes were evaluated during a mean follow-up of 6.2 ± 4 years. None, one or both internal thoracic arteries (ITAs) were used in 6.3, 29 and 64.7 % of cases, respectively. There were 16 (5.3 %) hospital deaths. Prolonged invasive ventilation (17.7 %), acute kidney injury (14.7 %) and multiple blood transfusion (21.3 %) were the most frequent major postoperative complications. The 10-year non-parametric estimates of freedom from all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were 47.8 [95 % confidence interval (CI) 44.1-51.5], 65.3 (95 % CI 61.4-69.2), and 42.3 % (95 % CI 38.3-46.3), respectively. Shared predictors of decreased late survival and MACCEs were old age (P < 0.04), chronic lung disease (P < 0.01), chronic dialysis (P < 0.0001) and extracardiac arteriopathy (P < 0.045). After adjustment for corresponding risk factors, freedom from cardiac death was higher when both ITAs were used but only for patients with significant increase of LV ejection fraction early after surgery (P = 0.04). In patients with LV dysfunction, CABG may be performed with acceptable hospital mortality and long-term survival. Late outcomes depend mainly on preoperative characteristics of the patients. The use of both ITAs for myocardial revascularization may give long-term survival benefits but only for patients whose LV function improves significantly early after surgery.
authors.affiliation: Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy. gius.gatti@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Maschietto
authors.affiliation: Divisions of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Dell'Angela
authors.affiliation: Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Benussi
authors.affiliation: Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Forti
authors.affiliation: Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy.
authors.forename: Lorella
authors.initials: L
authors.lastname: Dreas
authors.affiliation: Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy.
authors.forename: Petar
authors.initials: P
authors.lastname: Soso
authors.affiliation: Divisions of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Russo
authors.affiliation: Divisions of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Pappalardo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: Cardiomyopathy; Coronary artery bypass grafting; Outcomes