Back to Search
Start Over
Coronary artery bypass grafting and heart transplantation in end-stage coronary artery disease: a comparison of hemodynamic improvement and ventricular function.
- Source :
-
Journal of cardiac surgery [J Card Surg] 1994 Mar; Vol. 9 (2), pp. 77-84. - Publication Year :
- 1994
-
Abstract
- Heart transplantation has now become an accepted treatment for end-stage coronary heart disease (CAD). However, the limited supply of suitable donor organs imposes constraints upon the decision of whether patients are selected for transplantation or for coronary artery bypass grafting (CABG). From April 1986 until the end of March 1992, 265 patients with end-stage CAD involving left ventricular ejection fraction (LVEF) 10% to 30% and predominant angina pectoris underwent CABG. All patients received an average of 2.9 +/- 0.3 venous grafts. Intraaortic balloon pumps were implanted in 30 patients (11.3%) who began to develop low cardiac output syndrome intraoperatively. The actuarial survival rate was 87.8% after 2 years and 86.9% after 3 years. LVEF was measured in 35 patients via left heart catheterization 12 months after their operations and was found to have increased from a mean of 23.8% to 38.1%. Left ventricular end-diastolic pressure had decreased from 16.2 mmHg to an average of 12.1 mmHg. Swan-Ganz catheterization was performed on 120 patients 6 months postoperatively. The pulmonary wedge pressure had reduced significantly from 18.1 mmHg to a mean of 12.7 mmHg (p < 0.01). From 1990 until the end of March 1992, 55 patients with CAD and predominant heart failure received transplants. Their 2-year survival rate was 66.3%. Mean LVEF was 55.6% postoperatively. We conclude that CABG is adequate for patients who have end-stage CAD and angina pectoris symptoms, and that it significantly improves hemodynamic functions. Patients suffering predominantly from heart failure (NYHA Class IV) can be transplanted and subsequently regain normal heart function.
- Subjects :
- Actuarial Analysis
Adult
Aged
Aged, 80 and over
Cardiac Catheterization
Catheterization, Swan-Ganz
Coronary Disease classification
Coronary Disease complications
Coronary Disease diagnosis
Coronary Disease mortality
Female
Follow-Up Studies
Humans
Intra-Aortic Balloon Pumping
Male
Middle Aged
Severity of Illness Index
Survival Rate
Angina Pectoris etiology
Coronary Artery Bypass
Coronary Disease physiopathology
Coronary Disease surgery
Heart Failure etiology
Heart Transplantation
Hemodynamics
Terminal Care
Ventricular Function
Subjects
Details
- Language :
- English
- ISSN :
- 0886-0440
- Volume :
- 9
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of cardiac surgery
- Publication Type :
- Academic Journal
- Accession number :
- 8012104
- Full Text :
- https://doi.org/10.1111/j.1540-8191.1994.tb00829.x