Short Term Follow-up of Low Ejection Fraction Patients in Townsville

Abstract

Purpose: Patients with poor ejection fraction (EF) are often considered high risk candidates for cardiac surgery and require extensive preoperative multidisciplinary planning as they are often associated with increased morbidity and mortality. Methodology: A retrospective audit was conducted on all patients with an EF of 30% or less who underwent cardiac surgery in Townsville in 2014 and 2015. Information was collected regarding: patient demographics; preoperative morbidities; EF; surgical details; use of levosimendan and patient status at most recent follow-up (6 or 12 months post op). Results: There were 25 patients, 84% male and 16% female, with a mean EF of 26.3% (SD 8.0) and a mean age of 58.6 (SD 11.7). Hypertension (64%) and smoking (80%) were the most prevalent risk factors amongst the group. 64% presented urgently for surgery with 32% having had a STEMI. 92% had CABG or CABG with valve surgery. Preoperative optimisation included the use of IABP (64%) and levosimendan (36%). There was a 4% mortality at follow-up and 72% had a postoperative echo, of which 76% showed an improvement of EF. The average improvement was 14% (SD 7.74%). 36% of these had IABPs, 36% had IABP and levosimendan and 28% had neither. Of those, the patients who had both IABP and levosimendan had the greatest increase in ejection fraction at follow up (17% as opposed to 13%) although this was not a statistically significant difference. Conclusion: With more options available for stenting, an increasing number of low EF patients are presenting for surgery. Consideration of IABP or use of levosimendan in conjunction with other preoperative management may increase EF in short-term follow-up and could be improve morbidity for this group of high risk surgical patients.