title: Cardiac surgery improves survival in advanced left ventricular dysfunction: multivariate analysis of a consecutive series of 4491 patients over an 18-year period.
abstract: OBJECTIVE
  Risks of cardiac surgery in patients with poor [ejection fraction (EF) ≤ 30%] and very poor left ventricular (LV) function (EF ≤ 20%) may be considered high due to increased mortality. We examine our results in this cohort of patients.
  
  
  METHODS
  Data were prospectively collected and retrospectively analysed from 4491 consecutive patients referred for cardiac surgery over 18 years (July 1993-June 2012). Univariate predictors of in-hospital postoperative mortality were analysed by the appropriate tests. Variables with P < 0.1 were entered into multivariable logistic-regression model to identify predictors of in-hospital postoperative mortality, with data presented as odds ratios; P < 0.05 was statistically significant. Data on long-term survival and cardiac-specific mortality were obtained from the UK Office for National Statistics; the date of last follow-up was 13 October 2013 for the alive patients. Univariate predictors influencing cardiac death were determined by log-rank method. Variables with P < 0.1 were entered into multivariable Cox regression model to determine independent predictors of long-term survival, with data presented as hazard ratios; P < 0.05 was statistically significant.
  
  
  RESULTS
  Cardiac surgery was performed on 3890 consecutive patients (74.7% male, age 68.7 ± 8.1 years); 601 patients did not undergo surgery. Postoperative hospital mortality was 2.9% (n = 112/3890). Predictors of postoperative hospital mortality included age ≥ 70 years, female sex, hypertension, LVEF < 50%, neurological dysfunction, previous cardiac surgery, early time period 1993-1997, emergency procedures and triple procedures. All patients were followed until the date of last follow-up or date of death, with a median follow-up of 8.1 ± 7.6 years and a total follow-up of 33 208 years. There were 533 (13.7%) postoperative early and late deaths from cardiac causes. Predictors of long-term survival free from cardiac death included LVEF > 50%. Predictors of postoperative cardiac deaths in the long-term follow-up included older age, diabetes, neurological dysfunction, LVEF < 50%, non-coronary artery bypass surgery, early time period of surgery (1993-1997) and redo-cardiac surgery.
  
  
  CONCLUSIONS
  Cardiac surgery provides long-term survival benefit in all subsets of LV function, including advanced LV dysfunction.
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Balakrishnan
authors.initials: B
authors.lastname: Mahesh
authors.affiliation: NHS statistician, Camden Clinical Commissioning Group, London, UK.
authors.forename: Prasanth
authors.initials: P
authors.lastname: Peddaayyavarla
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Lay Ping
authors.initials: LP
authors.lastname: Ong
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Sonya
authors.initials: S
authors.lastname: Gardiner
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK sam.nashef@papworth.nhs.uk.
authors.forename: Samer A M
authors.initials: SA
authors.lastname: Nashef
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000401:mortality
keywords: Advanced left ventricular dysfunction; Cardiac surgery; Left ventricle