Aorta-coronary bypass grafting in patients with severe left ventricular dysfunction

Abstract

Twenty-five patients with severe left ventricular (LV) dysfunction (radiologic cardiomegaly, ejection fraction of ≤ 0.35) were operated upon for severe coronary artery disease (CAD). The long-term survivors were reviewed to see if LV function improved. Preoperatively all patients had angina pectoris, 72% had congestive heart failure (CHF), and 92% had had one or more myocardial infarctions. Critical stenoses in two or three major coronary vessels were present in all patients, and six in addition were found to have left main coronary artery stenosis. An average of 3.5 grafts per patient were inserted. The surgical mortality rate was 12% (three patients). Twenty (80%) patients were alive at an average interval of 21 months (range 8 to 42) postoperatively. All had partial or complete relief of angina and 85% had no heart failure. LV ejection fraction was measured by radionuclide angiography at a mean time of 19 months postoperatively in 18 survivors. It was unchanged in 12 who had two- and 3-vessel disease (0.23 ± 0.06 [mean ± SD] preoperatively versus 0.25 ± 0.09 postoperatively, p > 0.05) but improved in six with main left coronary disease (0.24 ± 0.06 preoperatively versus 0.40 ± 0.14 postoperatively, p < 0.01). The actuarial 18 month survival rate for the entire group was 82%. Aorta-coronary artery bypass grafting (ACBG) can be performed in patients with CAD and severe LV dysfunction with good relief of angina and a favorable long-term survival rate. Heart failure is usually improved clinically but, except in the case of main left coronary disease, the measured LV function at rest is unchanged.