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[Surgical treatment of ischemic heart disease complicated with severe left ventricular dysfunction: experience in 200 cases]

Authors :
P, Di Biasi
R, Scrofani
S, Moriggia
M, Di Biasi
M, Botta
M, Mariani
C, Santoli
Source :
Giornale italiano di cardiologia. 26(10)
Publication Year :
1996

Abstract

The study was designed to evaluate short and long-term benefits of coronary artery bypass graft in patients with coronary artery disease and severely depressed left ventricular ejection fraction and to identify contemporary risk factors associated with significantly greater mortality in this high-risk subgroup.From 1985 to 1995, 200 consecutive pts with EFor = 0.30 underwent CABG. Among these patients, 60% were older than 70 years. NYHA functional class III/IV was present in 31% of pts. Preoperative mean cardiac index was 2.7 +/- 7 l/min/m2, mean pulmonary artery pressure was 29.9 +/- 7 mm Hg and contractility score (generated by appropriate software for left ventricular kinesis analysis) mean value was 50.1 +/- 11.6 points. Urgent operation was required in 32 pts (16%). The majority of pts were completely revascularized.Operative mortality was 9% (18 pts). Low output syndrome was the most common postoperative complication (13.5%) followed by ventricular arrhythmia (8%), mean length of postoperative hospitalization for survivors was 13 +/- 10 days. Of 23 possible operative risk factors evaluated, four were associated with significantly greater mortality: cardiac indexor = 2.1 l/min/m2, urgent operation, contractility scoreor = 80 and associated surgical procedures. Survivors experienced significant improvement in CHF class (p0.001) and follow up EF (p0.001). Kaplan-Meier estimate of survival at 1 year, 5 years and 8 years was 85%, 65% and 54%.Through more careful assessment of preoperative risk factors, patients selection and perioperative management, actually coronary artery bypass graft may be offered to pts with low ejection fraction with reduced morbidity and mortality.

Details

ISSN :
00465968
Volume :
26
Issue :
10
Database :
OpenAIRE
Journal :
Giornale italiano di cardiologia
Accession number :
edsair.pmid..........12ca9ec75130eab3c44aac42e97a6cde