[Long-term outcome of surgical revascularization in patients with ischemic heart disease and left ventricular dysfunction].
OBJECTIVE
To analyze the long-term results and risk factors of surgical revascularization in patients with ischemic heart disease (IHD) and left ventricular dysfunction (LVD).


METHODS
From January 2003 to July 2013, 2 132 patients underwent coronary artery bypass grafting (CABG) in our institution. Among them, 318 patients with LVD[left ventricular ejection fraction (LVEF) ≤50%]were included in the final study. There were 26 6 male and 52 female patients with age from 36 to 83 (63±9) years old. 76 patients underwent off-pump CABG (OPCAB) and 242 patients underwent conventional CABG (CCABG). Risk factors, perioperative results and follow-up data were collected and analyzed with cox hazard ratio model.


RESULTS
Among 318 patients, 6 cases died of the operation with a hospital mortality of 1.9%. With follow-up time from 1 to 128(45.5±32.4)months, 25 patients were lost of follow-up, causing a follow-up rate of 92.0%. Among the 287 cases with long-term follow-up results, all-cause death, cardiogenic death and re-hospitalization due to heart failure were 14.6% (42/287), 5.9%(17/287), 14.6% (42/287), respectively. Re-revascularization rate, recurrent angina and myocardial infarction rate and cerebral incidence were 3.5%(10/287), 13.6% (39/287), 1.7%(5/287), respectively. The five-year survival rate was 85.6%. With all-cause death as the endpoint, preoperative LVEF (HR=0.943, 95%CI: 0.893-0.995, P=0.031) and perioperative implantation of IABP (HR=2.509, 95%CI: 1.051-5.992, P=0.038) emerged as the risk factors that affected the long term survival. The five-year survival rate of patients with severe LVD (LVEF≤35%) was significantly lower than that of patients with mild to moderate LVD (35%<LVEF≤50%) (70.4% vs 86.1%, P=0.025).


CONCLUSIONS
Preoperative LVEF and perioperative implantation of IABP had adverse effect on long-term survival of patients with IHD and LVD undergoing surgical revascularization. The long-term survival of patients with severe LVD was significantly lower than those with mild to moderate LVD. The long-term survival significantly decreased among patients undergoing peri-operative implantation of IABP.
Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing 100853, China.
R
R
Wang
C Q
CQ
Gao
C S
CS
Xiao
Y
Y
Wu
C L
CL
Ren
Z Y
ZY
Gong
Y
Y
Wang
G P
GP
Liu
M Y
MY
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006333:Heart Failure; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000601:surgery*; D016277:Ventricular Function, Left