Abstract
Objective
Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction has been considered to be a challenging operation. We assessed the early angiographic and long-term clinical and functional outcomes of patients with poor left ventricular function who underwent isolated CABG.
Methods
We retrospectively reviewed the records of 78 patients with a poor left ventricular ejection fraction (35% or less) who underwent isolated CABG between January 1991 and November 2006. The mean age of the patients was 66.1 ± 9.4 years, and their mean New York Heart Association functional class was 3.1 ± 0.8. Their mean end-diastolic left ventricular diameter was 57.4 ± 8.1 mm, and their mean grade of mitral regurgitation was 0.7 ± 1.0. Early postoperative angiograms were performed at 32.5 ± 33.5 days after the operation. Interval echocardiographic data were analyzed, and the long-term survival rate was evaluated.
Results
The average number of distal anastomoses per patient was 3.2 ± 1.1. The operative mortality rate was 7.7%. Stroke occurred in 1.3% of patients. The overall patency rates for arterial and venous grafts were 100% and 97.2%, respectively. The left ventricular ejection fraction significantly improved from 28.2% ± 5.1% to 34.4% ± 8.4%. Both the end-diastolic and end-systolic left ventricular dimensions significantly decreased from 57.4 ± 8.1 to 55.1 ± 8.8 mm and from 47.4 ± 8.4 to 45.1 ± 9.7 mm, respectively. The actuarial patient survival rate at 10 years was 73.1%.
Conclusion
CABG in patients with left ventricular dysfunction was effective, with favorable early graft patency rates. The long-term outcome was also acceptable, with echocardiographic functional recovery.
Similar content being viewed by others
References
JJ DeRose SuffixJr IK Toumpoulis SK Balaram JP Ioannidis S Belsley RC Ashton SuffixJr et al. (2005) ArticleTitlePreoperative prediction of long-term survival after coronary artery bypass grafting in patients with low left ventricular ejection fraction J Thorac Cardiovasc Surg 129 314–21 Occurrence Handle15678041 Occurrence Handle10.1016/j.jtcvs.2004.05.022
LL Mickleborough S Carson M Tamariz J Ivanov (2000) ArticleTitleResults of revascularization in patients with severe left ventricular dysfunction J Thorac Cardiovasc Surg 119 550–7 Occurrence Handle10694616 Occurrence Handle10.1016/S0022-5223(00)70135-8 Occurrence Handle1:STN:280:DC%2BD3c7mtVyisw%3D%3D
OM Shapira CT Hunter E Anter Y Bao K DeAndrade HL Lazar et al. (2006) ArticleTitleCoronary artery bypass grafting in patients with severe left ventricular dysfunction: early and mid-term outcomes J Card Surg 21 225–32 Occurrence Handle16684046 Occurrence Handle10.1111/j.1540-8191.2006.00221.x
GS Hillis KJ Zehr AW Williams HV Schaff TA Orzulak RC Daly et al. (2006) ArticleTitleOutcome of patients with low ejection fraction undergoing coronary artery bypass grafting: renal function and mortality after 3.8 years Circulation 114 IssueID1 Suppl I414–9 Occurrence Handle16820610
VK Topkara FH Cheema S Kesavaramanujam ML Mercando AF Cheema PB Namerow et al. (2005) ArticleTitleCoronary artery bypass grafting in patients with low ejection fraction Circulation 112 IssueID9 Suppl I344–50 Occurrence Handle16159844
J Appoo C Norris S Merali MM Graham A Koshal ML Knudtson et al. (2004) ArticleTitleLong-term outcome of isolated coronary artery bypass surgery in patients with severe left ventricular dysfunction Circulation 110 IssueID11 Suppl 1 II13–7 Occurrence Handle15364831
PJ Shah DL Hare JS Raman I Gordon RK Chan JD Horowitz et al. (2003) ArticleTitleSurvival after myocardial revascularization for ischemic cardiomyopathy: a prospective ten-year follow-up study J Thorac Cardiovasc Surg 126 1320–7 Occurrence Handle14666002 Occurrence Handle10.1016/S0022-5223(03)00809-2
R Ascione P Narayan CA Rogers KH Lim R Capoun GD Angelini (2003) ArticleTitleEarly and midterm clinical outcome in patients with severe left ventricular dysfunction undergoing coronary artery surgery Ann Thorac Surg 76 793–9 Occurrence Handle12963202 Occurrence Handle10.1016/S0003-4975(03)00664-7
JA Carr BE Haithcock G Paone AF Bernabei NA Silverman (2002) ArticleTitleLong-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction Ann Thorac Surg 74 1531–6 Occurrence Handle12440604 Occurrence Handle10.1016/S0003-4975(02)03944-9
F Bouchart A Tabley PY Litzler C Haas-Hubscher JP Bessou R Soyer (2001) ArticleTitleMyocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long-term follow-up in 141 patients Eur J Cardiothorac Surg 20 1157–62 Occurrence Handle11717021 Occurrence Handle10.1016/S1010-7940(01)00982-4 Occurrence Handle1:STN:280:DC%2BD3MnntFejtA%3D%3D
R Lorusso G La Canna C Ceconi V Borghetti P Totaro G Parrinello et al. (2001) ArticleTitleLong-term results of coronary artery bypass grafting procedure in the presence of left ventricular dysfunction and hibernating myocardium Eur J Cardiothorac Surg 20 937–48 Occurrence Handle11675178 Occurrence Handle10.1016/S1010-7940(01)00945-9 Occurrence Handle1:STN:280:DC%2BD3MrmvVaksw%3D%3D
T Ikuta H Fujii T Shibata K Hattori H Hirai H Kumano et al. (2004) ArticleTitleA new poly-2-methoxyethylacrylate-coated cardiopulmonary bypass circuit possesses superior platelet preservation and inflammatory suppression efficacy Ann Thorac Surg 77 1678–83 Occurrence Handle15111165 Occurrence Handle10.1016/j.athoracsur.2003.10.060
H Kumano S Suehiro K Hattori T Shibata Y Sasaki M Hosono et al. (1999) ArticleTitleCoagulofibrinolysis during heparin-coated cardiopulmonary bypass with reduced heparinization Ann Thorac Surg 68 1252–6 Occurrence Handle10543488 Occurrence Handle10.1016/S0003-4975(99)00697-9 Occurrence Handle1:STN:280:DC%2BD3c%2FgvVygsQ%3D%3D
T Fukui S Suehiro T Shibata K Hattori H Hirai (2002) ArticleTitleRetropericardial hematoma complicating off-pump coronary artery bypass surgery Ann Thorac Surg 73 1629–31 Occurrence Handle12022565 Occurrence Handle10.1016/S0003-4975(01)03461-0
EL Alderman LD Fisher P Litwin GC Kaiser WO Myers C Maynard et al. (1983) ArticleTitleResults of coronary artery surgery in patients with poor left ventricular function (CASS) Circulation 68 785–95 Occurrence Handle6352078 Occurrence Handle1:STN:280:DyaL2c%2Fgt1GltA%3D%3D
CM O'Connor EJ Velazquez LH Gardner PK Smith MF Newman KP Landolfo et al. (2002) ArticleTitleComparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank) Am J Cardiol 90 101–7 Occurrence Handle12106836 Occurrence Handle10.1016/S0002-9149(02)02429-3
AK Darwazah RA Abu Sham'a E Hussein MH Hawari H Ismail (2006) ArticleTitleMyocardial revascularization in patients with low ejection fraction < or = 35%: effect of pump technique on early morbidity and mortality J Card Surg 21 22–7 Occurrence Handle16426343 Occurrence Handle10.1111/j.1540-8191.2006.00163.x
F Nurozler ST Kutlu G Kucuk (2006) ArticleTitleCoronary by-pass for bad ventricle; adoption of “hybrid-pump” bypass J Cardiothorac Surg 1 44 Occurrence Handle17109751 Occurrence Handle10.1186/1749-8090-1-44
EE McCarron MJ Shackcloth AD Grayson WC Dihmis (2005) ArticleTitleLeft internal mammary artery use in patients with poor left ventricular ejection fraction: a propensity-matched analysis of mid-term survival Interact CardioVasc Thorac Surg 4 184–8 Occurrence Handle17670388 Occurrence Handle10.1510/icvts.2004.102707
CA Dietl MD Berkheimer EL Woods CL Gilbert WF Pharr CH Benoit (1996) ArticleTitleEfficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less Ann Thorac Surg 62 401–8 Occurrence Handle8694598 Occurrence Handle10.1016/0003-4975(96)00314-1 Occurrence Handle1:STN:280:DyaK28zgvFGmtA%3D%3D
JA Elefteriades DL Morales C Gradel G Tollis SuffixJr E Levi BL Zaret (1997) ArticleTitleResults of coronary artery bypass grafting by a single surgeon in patients with left ventricular ejection fractions < or = 30 Am J Cardiol 79 1573–8 Occurrence Handle9202343 Occurrence Handle10.1016/S0002-9149(97)00201-4 Occurrence Handle1:STN:280:DyaK2szksFymsw%3D%3D
JA Elefteriades G Tolis SuffixJr E Levi LK Mills BL Zaret (1993) ArticleTitleCoronary artery bypass grafting in severe left ventricular dysfunction: excellent survival with improved ejection fraction and functional state J Am Coll Cardiol 22 1411–7 Occurrence Handle8227799 Occurrence Handle1:STN:280:DyaK2c%2FksVamsg%3D%3D Occurrence Handle10.1016/0735-1097(93)90551-B
U Boeken P Feindt J Litmathe E Gams (2004) ArticleTitleComparison of complete and incomplete revascularization in CABG patients with severely impaired left ventricular function (LVF) Z Kardiol 93 216–21 Occurrence Handle15024589 Occurrence Handle10.1007/s00392-004-0043-y Occurrence Handle1:STN:280:DC%2BD2c7jt1Wktg%3D%3D
WP Miller BP Flygenring SH Nellis (1988) ArticleTitleEffects of load alteration and coronary perfusion pressure on regional end-systolic relations Circulation 78 IssueID5 Pt 1 1299–309 Occurrence Handle3180386 Occurrence Handle1:STN:280:DyaL1M%2FivFSntg%3D%3D
E Sharoni HK Song RJ Peterson RA Guyton JD Puskas (2006) ArticleTitleOff-pump coronary artery bypass surgery for significant left ventricular dysfunction: safety, feasibility, and trends in methodology over time: an early experience Heart 92 499–502 Occurrence Handle15994913 Occurrence Handle10.1136/hrt.2005.062778 Occurrence Handle1:STN:280:DC%2BD287kvVCitw%3D%3D
KV Arom TF Flavin RW Emery VR Kshettry RJ Petersen PA Janey (2000) ArticleTitleIs low ejection fraction safe for off-pump coronary bypass operation? Ann Thorac Surg 70 1021–5 Occurrence Handle11016367 Occurrence Handle10.1016/S0003-4975(00)01761-6 Occurrence Handle1:STN:280:DC%2BD3cvmtlGgtQ%3D%3D
H Shennib M Endo O Benhamed JF Morin (2002) ArticleTitleSurgical revascularization in patients with poor left ventricular function: on- or off-pump? Ann Thorac Surg 74 S1344–7 Occurrence Handle12400814 Occurrence Handle10.1016/S0003-4975(02)03966-8
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fukui, T., Shibata, T., Sasaki, Y. et al. Long-term survival and functional recovery after isolated coronary artery bypass grafting in patients with severe left ventricular dysfunction. Gen Thorac Cardiovasc Surg 55, 403–408 (2007). https://doi.org/10.1007/s11748-007-0148-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-007-0148-0