Bypass Graft Patients Research Articles

Early Outcomes of Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

Background: Patients with low ejection fraction (EF) are at a higher risk for postoperative complications and mortality. Our objective was to assess the effect of low EF (<40%) on early clinical outcomes after coronary artery bypass grafting (CABG) and to determine the predictors of mortality.
 Methods: From June 2017 to February 2019, 170 consecutive patients underwent CABG. There were 120 patients with low EF (<40%; 37.49 ± 2.89%); 94 were men (78.3%), and the mean age was 55.83 ± 8.04 years. Fifty patients had normal EF (> 40; 57.90 ± 2.27 %), 41 were men (82.0%), and the mean age was 54.30 ± 7.01 years and used as a control group.
 Results: Overall 30-day mortality was 10/120 patients (8.3%). Factors associated with higher mortality were females ( 70.0% vs. 17.3%, P<0.001); older age (61.40 ± 7.01 vs. 55.32 ± 7.97 years, P=0.025); diabetes mellitus (100% vs. 51.8%; P=0.003); longer cardiopulmonary bypass time (148.70 ± 40.12 vs. 108.49 ± 36.89 min; P=0.012); longer cross clamp time (88.19 ± 31.94 vs.64.77 ± 22.67 min; P=0.049), longer total operative time (6.82 ± 1.03 vs 5.38 ± 0.95 hours; P=0.001); intra-aortic balloon pump (IABP) insertion (90.0% vs. 10.9%; P<0.001); intra-operative complications (60% vs. 1.8%, P<0.001); ventricular tachycardia and ventricular fibrillation (30% and 50% vs. 4.5% and 5.5% respectively; P=0.002 for both); myocardial infarction (70% vs 11.8%, P<0.001), and lower postoperative ejection fraction (21.46 ± 1.93 vs 40.30 ± 8.19 %, P<0.001). In patients with low EF, postoperative NYHA and CCS angina class have improved compared to the preoperative levels (1.50 ± 0.61 vs. 3.31 ± 0.56; p< 0.001 and 1.38 ± 0.52 vs. 3.11 ± 0.55; p< 0.001 respectively)
 Conclusion: Patients with low EF have a higher risk of morbidity and mortality; however, the clinical and echocardiographic parameters improve over time. Therefore, CABG remains a viable option in selected patients with low EF. Factors affecting our 30-days mortality were related to the severity of the disease.

Coronary artery bypass grafting in patients with low ejection fraction: what are the risk factors?

Left ventricular (LV) dysfunction alone is insufficient as an independent predictor of postoperative complications and mortality in coronary artery bypass graft (CABG) surgery. Our objective was to identify additional independent risk factors in patients with low left ventricle ejection fraction (EF) who underwent CABG. We retrospectively analyzed CABG results of 346 consecutive patients with low EF (≤30%) in a single institution between 2009 and 2015. The primary study endpoint was 30-day all-cause mortality. The secondary endpoints were the development of major adverse cardiac events (MACE) and renal complications after operation. A subgroup of patients underwent additional analyses of the interaction between extents of viable myocardium and postoperative endpoints. The analysis showed that preoperative hemodynamic instability (AOR=4.57; 95% CI: 1.53-13.7, P=0.007) and serum creatinine >166 µmol/L (AOR=3.46; 95% CI: 1.12-10.7, P=0.031) were independent predictors of 30-day death. Both urgent and emergency operations were predictors for MACE (P=0.038; P=0.005) and renal complications (P=0.004; P=0.007). Pre-existing diabetes mellitus increased the likelihood of renal complications (P=0.020). In the sub-analysis of patients with viable myocardium, the mortality was significantly lower with predicted mortality (P=0.014). Patients with significant LV dysfunction undergoing isolated CABG have fair short-term survival even with EF less than 30%. Hemodynamic instability prior to operation and preoperative kidney dysfunction are strong predictors of mortality in patients with low EF. Favorable coronary targets, meticulous operative techniques, and optimal surgical timing before hemodynamic deterioration occurs are essential to minimize the risk of revascularization complications and early postoperative mortality.

Results of coronary artery bypass grafting in patients with chronic obstructive lung disease

This work is relevant because it studies the effect of chronic obstructive pulmonary disease on the incidence of complications after coronary artery bypass grafting in patients with ischemic lung disease. 118 histories of patients, who underwent CABG under conditions of artificial circulation and without it, on a working heart, were analyzed. It was found that in patients with CABG under conditions of infarction and concomitant chronic obstructive pulmonary disease, the period of artificial ventilation was significantly longer among all the assessed complications and features of the postoperative period than in the group of patients with CABG performed on a working heart.

Short Term Outcome of Off Pump Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

Coronary artery disease is increasing in developing countries. Revascularization surgery in such patients with amenable coronary anatomy is a valid option. Coronary artery bypass grafting in patients with low ejection fraction (EF <35%) is very challenging although it is performing successfully in department of Cardiac Surgery of Bangabandhu Sheikh Mujib Medical University now a days. The purpose of this study is to evaluate the safety and effectiveness of off pump coronary artery bypass grafting for EF e”35% and EF <35% and also to compare between pre and postoperative echocardiographic findings in this two groups. The preoperative, at discharge, 1 month and 3 month postoperative follow up data of total 60 patients in two groups ( EF e”35% and <35%) who underwent isolated off pump coronary artery bypass grafting between July 2012 – June 2014 was evaluated. In group 1 preoperative LVIDd and LVIDs was 54.86±3.45 mm and 45.23 ±4.13mm and LVEF was 42.7±4.66. Postoperatively at 3 month follow up the LVIDd 45.43±5.03 mm, LVIDs 34.7±5.33 mm and LVEF 53.46±5.06. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. But improvement of LVEF is not statistically significant (p>0.05). Similarly in group 2 patients preoperative LVIDd, LVIDs and LVEF is 67.06±3.67mm, 59.1±4.35mm and 29.26±4.25. Postoperatively at 3 months follow up of this group the LVIDd, LVIDs and LVEF is changed to 57.56±4.96 mm, 48.3±5.53 mm and 38.93±6.03. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. And the improvement of LVEF is also statistically significant (p<0.001). Significant improvement in terms of CCS grade and NYHA class was also observed specially in <35% ejection fraction group at 3moths follow up. We concluded that off pump coronary artery bypass grafting can be safely performed to the patients with normal and poor left ventricular ejection. Hence we recommended that off-pump CABG can be safely carry out in case of <35% ejection fraction patients.
 University Heart Journal Vol. 14, No. 2, Jul 2018; 53-61

Graft Strategy for Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction.

BackgroundOptimal graft selection for coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction remains debatable. We report an analysis of our experiences of isolated CABG in patients with severe LV dysfunction and the impact of graft strategy on long-term outcomes.MethodsWe analyzed 209 patients with severe LV dysfunction (ejection fraction [EF] <30%) who underwent primary isolated CABG. Of these, 169 were revascularized with a bilateral internal thoracic arterial (ITA) graft (BITA group) and 40 were revascularized with a single ITA graft (SITA group). The mean follow-up duration was 22±32 months.ResultsThere were 18 early deaths (8.6%). Overall survival at 5 years was 66.7%. The rate of freedom from cardiac-related death at 5 years was 74.1%, and was significantly higher in patients who underwent off-pump CABG (p=0.005) and in the BITA group (p=0.023). Multivariate analysis demonstrated that old age (hazard ratio [HR], 2.548; 95% confidence interval [CI], 1.134–5.762; p=0.024), off-pump CABG (HR, 0.245; 95% CI, 0.090–0.661; p=0.006), and BITA grafts (HR, 0.333; 95% CI, 0.146–0.757; p=0.009) were correlated with cardiac mortality.ConclusionCABG in patients with severe LV dysfunction (EF <30%) showed reasonable long-term outcomes. The rate of freedom from cardiac-related death was significantly higher in patients who underwent off-pump CABG and in the BITA group. Off-pump BITA grafting strategies can be accepted as a viable primary option in patients with severe LV dysfunction if performed by an experienced surgeon.

A case of off-pump coronary artery bypass grafting for single coronary artery

A single coronary artery is a congenital anomaly of the coronary arteries, in which the whole heart is supplied with a single coronary artery, which has one source of filling and leaves one orifice from one coronary sinus. Anomalies of coronary arteries are among the rare congenital heart defects. This defect is commonly detected in patients with coronary artery disease during selective coronary angiography. Single observations of coronary artery bypass grafting in patients with single coronary artery have been presented.

Clinical and functional evaluation of intramyocardial implantation of autologous bone marrow cells treated with erythropoietinduring the CAD surgery (6-month results)

Aim.Clinical and functional evaluation of the implantation of autologous bone marrow cells treated with erythropoietin in laser channels during coronary bypass grafting in patients with end-stage coronary lesion.Materials and methods.60 patients with coronary artery disease with diffuse and (or) distal right coronary artery disease were randomized into two groups: patients of group 1 (n = 30) underwent coronary bypass grafting, implantation of autologous bone marrow cells treated with erythropoietin in laser channels, patients of the 2nd group (n = 30) were operated with coronary bypass grafting of the left coronary artery system. Assessment of the clinical status, myocardial perfusion and contractility was performed initially, 6 months after the operation.Results.Six months after the operation, there was a more pronounced decrease in angina pectoris (CCS) in the main group compared to the control group, also we revealed a 6-minute walk test scores improvement. Based on two-stage scintigraphy (Tc99) in the main group before the surgical treatment, a rest perfusion defect was 8.5% [3.5, 18.5], a stress-induced perfusion defect – 7.0% [6.0, 12, 3]. In the control group, the rest defect was 9.1% [5.6, 12.4], the stress-induced perfusion defect was 7.3% [6.1, 8.7]. 6 months after surgery rest perfusion defect at the indirect revascularization group was 6.0% [2.5, 16.5] (p = 0.008), a stress-induced defect was 4.0% [1.5, 6.3] (p = 0.05). In the control group, the rest defect was 8.7% [5.3, 10.3], the stress-induced perfusion defect was 6.8% [5.3, 9.1] (p = 0.21). The results of scintigraphy with MIBG showed a left ventricle innervation defect (PID) significant decrease in the main group: initially 15.4% [14.2, 16.3], after 6 months 11.7% [9.3, 13, 2] (p = 0.045). In the control group, there was an unreliable decrease in PID: initially 14.3% [10.2, 17.3], after 6 months 13.8% [9.1, 14.2] (p = 0.14).Conclusion.Our preliminary results revealed more pronounced effect of the new indirect revascularization method expressed as in myocardial perfusion improve, myocardial sympathetic innervation restoration and clinical status improvement in comparison with control group.

75-Year-Old Man With Chest Pain and Dyspnea

75-Year-Old Man With Chest Pain and Dyspnea

Predictors of early occlusion of coronary bypass grafts in patients with extremely low ejection fraction

The authors carried out a retrospective study aimed at revealing predictors of early incompetence of coronary bypass grafts in patients with the ejection fraction below 30%. The study included a total of 104 patients presenting with coronary artery disease and the ejection fraction below 30%, who over the period from 2009 to 2016 underwent coronary artery bypass grafting with the use of autovenous and autoarterial conduits. 77 patients endured plasty of an aneurysm of the left ventricle (LV), 89 patients sustained plasty of the valvular apparatus. All patients were subjected to control coronary bypass angiography (CBA) within 12 postoperative months. Thus, we analysed a total of 184 autoarterial and 84 autovenous shunts. The findings of CBA revealed occlusions of 2 (1%) arterial and 10 (11%) venous conduits. Analysing the coronary bypass angiographies of the patients ranked according to the values of the effective stroke volume index demonstrated the following regularity: a decrease in the LV effective stroke volume index of less than 30 ml/m2 was accompanied bу increased incidence of thrombosis of autovenous shunts in the immediate postoperative period. Predictors of early occlusion of coronary bypass grafts were revealed by means of the Cox regression analysis. It was determined that using an autovein increased the risk of occlusion of the shunt by 26%, a decrease in the effective stroke volume index of the left ventricle by 1 ml/m2 increased the risk of early occlusion of coronary bypass grafts by 18%, a decrease in the diameter of the shunted artery by 0.5 mm increased the risk for early occlusion of the shunt by 12%, a decrease in the blood flow velocity (Qmean) by 1 ml/m2 increased the risk for occlusion of the shunt by 10%, a decrease in the peripheral resistance index (RI) by 1 unit elevated the risk of early occlusion of the bypass graft by 12%. Analysing the revealed independent predictors with the help of the neural network method demonstrated that the strongest influence on early incompetence of the coronary bypass graft was exerted by the type of the conduit and effective stroke index.

Results of coronary artery bypass grafting in patients of different age groups

Myocardial revascularization involves a wide range of invasive strategies aimed at treating ischaemic heart disease in patients of different age groups. The purpose of the present study was to analyze the outcomes of coronary artery bypass grafting in patients depending on age. A total of 905 patients enrolled in our study were subdivided into groups based on age-related characteristics (young age, middle age, old age, senile age). The endpoints of follow up were as follows: myocardial infarction, acute impairment of cerebral circulation, death and haemorrhagic complications. It should be mentioned that the groups were comparable by the majority of the parameters studied. No statistically significant differences in the frequency of the development of complications in the postoperative period were observed. However, amongst patients over 75 years old, revision of the mediastinum for haemorrhage was performed more often. Patients of different age groups undergoing coronary artery bypass grafting are extremely heterogeneous by the clinical, anamnestic, instrumental and intraoperative characteristics. A high frequency of haemorrhagic complications amongst patients over 75 years old may be explained by a more aggressive approach to the regimens of anticoagulant/antiaggregant therapy resulting form the presence of atrial fibrillation. In its turn, this fact determines the probability of a high frequency of the development of adverse cardiovascular events. An individual approach to the choice and scope of the strategy of revascularization in patients of different age groups is the fundamental principle for an optimal outcome of coronary surgery. The obtained findings and analysis of the statistical data are indicative of the necessity of personified selection of the technique of a surgical intervention for each particular patient, which will make it possible to decrease the rate of adverse cardiovascular events in the postoperative period.

In-hospital and one-year outcomes after coronary artery bypass grafting in patients with diffuse coronary artery disease

In-hospital and one-year outcomes after coronary artery bypass grafting in patients with diffuse coronary artery disease

Immediate and intermediate results of staged carotid endarterectomy in combination with coronary artery bypass grafting

The purpose of our investigation was to evaluate the immediate and intermediate results of staged operations of carotid endarterectomy and coronary artery bypass grafting in patients with multifocal atherosclerosis. We analysed a total of 475 operations. Of these, 371 (78.1%) patients underwent staged interventions (stage 1 - carotid endarterectomy, stage 2 - coronary artery bypass grafting). No neurological complications were observed after stage 1. Five (1.3%) patients developed cardiac arrhythmia in the form of atrial fibrillation, 7 (1.9%) were found to have transient neuropathy of cranial nerves. There were no lethal outcomes. Stage 2 was carried out 16±13 days after carotid endarterectomy. Of complications encountered, mention should be made of perioperative myocardial infarction in 1 (0.3%) patient, with 2 (0.6%) patients requiring emergency coronary bypass angiography. Newly onset atrial fibrillation was registered in 71 (19.1%) patients, haemorrhage followed by resternotomy in 6 (1.6%), and purulent wound complications in 4 (1.1%) patients. Death occurred in 1 (0.3%) patient. We also analysed the mid-term postoperative results (up to 32 months). The coverage amounted to 151 patients. The incidence rate of major adverse cardiac and cerebrovascular events (MACCE) was 6% (myocardial infarction - 2, acute cerebral ischaemia - 1, repeat myocardial revascularization - 5, lethal outcome - 1). Based on the obtained findings it may be concluded that staged operations on the carotid basin and coronary arteries by the number of complications are comparable to those after isolated coronary artery bypass grafting.

The features of the course of carotid bed atherosclerosis after coronary artery bypass grafting in patients with stable coronary heart disease

The features of the course of carotid bed atherosclerosis after coronary artery bypass grafting in patients with stable coronary heart disease

Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft

Management of stenosis of saphenous vein grafts in Coronary artery bypass graft (CABG) patients remains challenging despite the advance in interventional cardiology techniques. Rotational atherectomy is an adjunctive technique used in certain anatomical conditions in native coronary arteries; its use in saphenous vein graft is still contra-indicated by the manufacturer, and has only been reported in few cases in the literature. We report a case of a calcified, non-dilatable, distal saphenous vein graft to Circumflex lesion in a heart failure patient presenting with Non STEMI. The lesion was just proximal to the anastomosis and could not be crossed. Because of high surgical risk, and against manufacturer guidelines, rotational atherectomy of the lesion was performed and was successful with a very good angiographic result. Rotational atherectomy to facilitate percutaneous interventions in saphenous vein graft lesions is feasible, and could be attempted in experienced centers provided the absence of luminal thrombus or dissection.

On-pump beating-heart coronary artery bypass grafting: a literature review

Coronary artery bypass grafting techniques have been unchangeable for many years, whereas development and enhancement of myocardial protection methods in coronary bypass grafting for patients with ischemic heart disease are still actual issues of current coronary surgery. Coronary artery bypass grafting techniques include the traditional/conventional technique with cardiopulmonary bypass, aortic cross-clamping and cardioplegia, off-pump and on-pump beating heart coronary artery bypass grafting. Coronary artery bypass grafting with cardiopulmonary bypass and cardioplegia remains the most common method of coronary revascularization. However the cardiac arrest inevitably leads to global cardiac ischemia, and current cardioplegias do not prevent ischemic damage to the myocardium in all cases, especially in high-risk surgical patients. Off-pump coronary artery bypass grafting allows preventing global myocardial ischemia (due to the constant native coronary blood-flow) and avoiding possible negative consequences of cardiopulmonary bypass use. The main limitations of this technique are associated with high risk of hemodynamic instability due to low cardiac output and systolic output caused by target arteries exposition. On-pump beating heart technique is a reasonable compromise between conventional on-pump coronary artery bypass grafting, cardioplegia and off-pump procedure. It is a safe and effective technique with outcomes that are equivalent or superior to the outcomes reported for conventional coronary artery bypass grafting in patients with unstable hemodynamics, low left ventricular ejection fraction and in high-risk patients. The literature review presents the results of on-pump beating heart coronary artery bypass grafting.

Comparison of Outcomes and Frequency of Graft Failure With Use of Free Versus In Situ Internal Mammary Artery Bypass Conduits (from the PREVENT IV Trial)

Although in situ internal mammary artery (is-IMA) grafting remains the most frequent conduit in coronary artery bypass grafting (CABG), circumstances may necessitate free grafting of the IMA (f-IMA), though differences in outcomes have not been fully characterized. The purpose of this study was to compare clinical and angiographic outcomes of is-IMA versus f-IMA coronary bypass grafts in patients who underwent elective CABG surgery. In 1,829 patients in the angiographic cohort of PREVENT IV, 1,572 (85.9%) had at least 1 IMA graft; of these, 34 (2.2%) patients had at least 1 f-IMA graft and 1,538 (97.8%) had at least 1 is-IMA graft without additional f-IMA grafts. Characteristics of patients, procedure, and grafts/targets were compared between cohorts. Primary endpoints included death, myocardial infarction, and revascularization, as well as incidence of graft failure (stenosis >75%) on angiography at 12-18 months postoperatively. Patients receiving is-IMA grafts were more often of white race and higher weight. Aortic cross-clamp time was shorter in the f-IMA cohort (39.5 vs 57.0 min, p = 0.04), but duration of bypass was similar (93.5 vs 100.0 minutes, p = 0.793). Of the in situ grafts, 97.3% were via the left internal mammary artery (LIMA), 86.6% were of good quality, and the left anterior descending (LAD) was bypassed in 88.2%. This compares with free grafts, which were via the LIMA in 68.0%, of good quality in 96.1%, and bypassed the LAD in 58.8% and first obtuse marginal (OM1) in 23.5%. Rates of death, myocardial infarction, and revascularization were similar between groups. The rate of graft failure was higher in f-IMA grafts (23.3%) compared with is-IMA grafts (8.5%; p < 0.01). Although clinical outcomes were similar with use of free versus in situ IMA grafts, higher rates of graft failure were encountered with use of the f-IMA graft. In conclusion, in situ grafts should be the preferred conduit for patients who undergo CABG surgery.

Mid- and long-term prognosis of off- vs. on-pump coronary artery bypass graft in patients with multisite artery disease

Among patients with coronary artery disease (CAD), around 25% have multisite artery disease (MSAD). Patients with CAD and MSAD are at higher risk of peri-operative and long-term cardiovascular events. Whether off-pump coronary bypass grafting (CABG) can improve their prognosis is unknown. We aimed to assess the benefits of off- vs. on-pump cardiac surgery in patients undergoing CABG, according to coexistence of extra-cardiac artery disease. Between April 1998 and September 2008, 1221 patients undergoing CABG without any other intervention were enrolled. Overall death and major cardiovascular events were recorded at 1-month and during long-term follow-up. A propensity score (PS), derived from all relevant variables (P<0.25) associated with on-pump as compared to off-pump CABG, and representing the likelihood for each individual patient to receive off-pump CABG, was calculated. MSAD was observed in 279 patients (23%). Off-pump CABG was performed in 208 (17%) patients. The median follow-up was 7.6 years. The 10-year mortality was significantly lower in off- vs. on-pump CABG group (74±4% vs. 68±2%, P=0.024). In patients with MSAD, there was a trend for better survival for off- vs. on-pump CABG (63±8% vs. 50±4%, P=0.078). After adjustment for PS, we found no further difference between on- and off-pump CABG both in the whole cohort (HR=1.30, P=0.10), as well as in MSAD patients (HR=1.51, P=0.14). Patients with MSAD receiving CABG are at worst prognostic than those with isolated CAD. In these patients, we found no significant difference in the long-term mortality and cardiovascular events between on- and off-pump CABG.

Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection

This study reviewed our experience with coronary artery (CA) malperfusion secondary to type A aortic dissection. Between 2002 and 2017, 76 patients presented with CA malperfusion, with a dissection flap limited to the aorta in the region of the coronary ostium (type A lesion) in 26 (34%), with a dissection flap involving the CA itself (type B lesion) in 32 (42%), or with complete avulsion of the CA (type C lesion) in 18 (24%). Ostial repair was successfully performed in 23 type A patients (88%), in 20 type B patients (63%), and in no type C patient (0%). CA bypass grafting was performed when antegrade cardioplegia could not be applied in all 18 type C patients (100%) and in 5 type B patients (16%) because of a primary entry at the coronary ostium and in 7 patients (type A: 3 patients [12%], type B: 4 patients [13%]) with evidence of CA disease (p < 0.001). Perioperative mortality in patients with CA malperfusion was high (18 patients [24%]), but there was no difference in short-term (p= 0.153) or long-term survival (log-rank p= 0.542). Also, a landmark analysis showed equal survival of discharged patients with and without CA malperfusion (log-rank p= 0.645). We recommend CA bypass grafting in patients with type C lesions or in patients with underlying CA disease for optimal delivery of cardioplegia and ostial pledgetted suture repair in patients with type A lesions or type B lesions when the administration of antegrade cardioplegia is successful.

Society of Thoracic Surgeons Risk Score and EuroSCORE-2 Appropriately Assess 30-Day Postoperative Mortality in the STICH Trial and a Contemporary Cohort of Patients With Left Ventricular Dysfunction Undergoing Surgical Revascularization.

The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting. The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5 versus 2.9 for the CC and 0.9 versus 2.4 for the STICH cohort), and underestimated postoperative mortality risk. The STS and ES2 scores had moderately good C statistics: CC (0.727, 95% CI: 0.650-0.803 for STS, and 0.707, 95% CI: 0.620-0.795 for ES2); STICH (0.744, 95% CI: 0.677-0.812, for STS and 0.736, 95% CI: 0.665-0.808 for ES2). Despite the CC patients having higher STS and ES2 scores than STICH patients, mortality (3.5%) was lower than that of STICH (4.8%), suggesting a possible decrease in postoperative mortality over the past decade. The 30-day postoperative mortality risk of coronary artery bypass grafting in patients with left ventricular dysfunction varies markedly. Both the STS and ES2 score are effective in evaluating risk, although the STS score tend to underestimate risk. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.

Impact of Complete Revascularization on Long-Term Outcomes After Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction.

The long-term outcomes of complete revascularization (CR) in patients with left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) remain unclear. Methods and Results: We evaluated a consecutive series of 111 patients with LV ejection fraction ≤35% who underwent isolated first-time CABG: 63 underwent CR and 48 underwent incomplete revascularization (IR). At a median follow-up of 10.1 years, the rates of death from any cause, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE) were significantly greater in the IR group. After adjusting for propensity score, no significant difference was found between the CR and IR groups regarding death from any cause (hazard ratio [HR], 1.45; 95% CI: 0.75-2.81; P=0.271) and cardiac death (HR, 1.45; 95% CI: 0.68-3.10; P=0.337). In contrast, IR increased the risk of MACCE (HR, 1.92; 95% CI: 1.08-3.41; P=0.027), which was principally attributed to an increased risk of repeat revascularization (HR, 3.92; 95% CI: 1.34-11.44; P=0.013). Although IR was not significantly associated with an increased risk of long-term mortality in patients with LV dysfunction who underwent CABG, CR might reduce the risks of repeat revascularization and subsequent MACCE.