Abstract
This retrospective study evaluates early and midterm results in patients with severe left ventricular dysfunction. Ninety-seven consecutive patients with coronary artery disease and ejection fraction of left ventricle (LVEF) less or equal to 25 % underwent elective coronary artery bypass graft procedure between September 1998 and December 2001. Mean age at operation was 66 (47-86) years. The main symptoms were angina class III-IV Canadian Cardiovascular Society (CCS) in 78 patients (80 %) and dyspnoea class III-IV New York Heart Association (NYHA) in 43 patients (44 %). The major indications for surgery were severe angina, dyspnoea in 90 patients (93 %). Cardiac index (CI), echocardiography (ECHO), planimetry, end-diastolic pressure of left ventricle (LVEDP), end-diastolic diameter of left ventricle (LVEDd) were used to access left ventricular function preoperatively. ECHO was also used to access left ventricular function postoperatively. Early postoperative (30 days) mortality was 4.1 %. Complications had 25 patients (26 %) postoperatively. Two years survival was 95.7 %. Class III-IV CCS and/or NYHA had 17 patients (17.5 %) two years after surgery. LVEF (assessed by ECHO) improved from 23.1 % preoperatively to 36.0 % postoperatively (p < 0.05). The study showed that elective myocardial revascularisation in patients with severe left ventricular dysfunction and signs of myocardial viability is not necessarily associated with high operative mortality. It can be performed safely with respectable midterm survival in concordance with left ventricular function improvement, symptom relief and quality of life improvement.
Highlights
The results of the medical treatment of patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction are poor
Results supporting the use of coronary artery bypass graft (CABG) in patients with severe left ventricular dysfunction without case selection on the basis of viability studies or visibility of distal vessels has been reported by Mickleborough6
The degree of improvement in left ventricular function after revascularisation is dictated by the amount of viable myocardium2, 8
Summary
The results of the medical treatment of patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction are poor. As many earlier and current studies demonstrate coronary artery bypass graft (CABG) procedure have improved long term survival in patients with impaired ventricular function over the last fifteen years. Left ventricular function is an important predictor of early postoperative and late morbidity and mortality. Despite improvement in surgical techniques, myocardial protection and postoperative care, the surgical risk remains high and the procedure is still a major surgical challenge. Transmyocardial laser revascularisation and dynamic cardiomyoplasty are limited in use and in indications. Heart transplantation is a terminal one considering the impossibility of revascularisation and its dependence on donor heart availability as well
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Schedule a callMore From: Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
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