Skip to main content
Log in

Outcomes and long-term quality of life of patients with severe left ventricular dysfunction who underwent coronary artery bypass surgery

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to identify determinants of long-term results after coronary artery bypass surgery (CABG) in group of Iranian patients with systolic left ventricular (LV) dysfunction.

Methods

Reduced LV function was defined as an LV ejection fraction of <30%. Using our surgery database, we randomly selected 110 patients with EF < 30% and the same number of patients with EF ≥ 30% for whom demographic and clinical characteristics as well as inhospital postoperative outcomes were available. Followup data were completed for 94 patients with EF < 30% (85.5%) and 101 patients with EF ≥ 30% (91.8%). Longterm results of the operation and the patients’ quality of life were assessed for a mean follow-up period of 29.4 ± 11.0 months.

Results

In-hospital mortality and follow-up survival rates had no statistically differences in the low and normal EF groups (2.2% vs. 1.1% and 86.0% vs. 93.6%, respectively). Long-term surgical morbidity occurred in 43.6% of patients with severe LV dysfunction and in 38.6% of normal EF patients; it was considered similar for the two groups. Family history of coronary artery disease, New York Heart Association class IV, and moderate mitral insufficiency were the main predictors of long-term morbidity. Regarding the quality-of-life assessment, patients with severe LV dysfunction attained significantly lower levels of social activities.

Conclusion

Patients with severe LV dysfunction in comparison with those with normal LV function had similar 3-year survival rates and long-term complications. To improve survival following CABG in patients with severe LV dysfunction, mitral valve repair/replacement at the time of the initial operation should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Appoo J, Norris C, Merali S, Graham MM, Koshal A, Knudtson ML, et al. Long-term outcome of isolated coronary artery bypass surgery in patients with severe left ventricular dysfunction. Circulation 2004;110:13–17.

    Article  Google Scholar 

  2. Shapira OM, Hunter CT, Anter E, Bao Y, DeAndrade K, Lazar HL, et al. Coronary artery bypass grafting in patients with severe left ventricular dysfunction: early and mid-term outcomes. J Card Surg 2006;21:225–232.

    Article  PubMed  Google Scholar 

  3. DeRose JJ Jr, Toumpoulis IK, Balaram SK, Ioannidis JP, Belsley S, Ashton RC Jr, et al. Preoperative prediction of longterm survival after coronary artery bypass grafting in patients with low left ventricular ejection fraction. J Thorac Cardiovasc Surg 2005;129:314–321.

    Article  PubMed  Google Scholar 

  4. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Kini AS, Adams DH. Results and predictors of early and late outcome of coronary artery bypass grafting in patients with severely depressed left ventricular function. Ann Thorac Surg 2007;84:808–816.

    Article  PubMed  Google Scholar 

  5. Dries DL, Exner DV, Gersh BJ, Cooper HA, Carson PE, Domanski MJ. Racial differences in the outcome of left ventricular dysfunction. N Engl J Med 1999;340:609–616.

    Article  PubMed  CAS  Google Scholar 

  6. Thomas KL, East MA, Velazquez EJ, Tuttle RH, Shaw LK, O’Connor CM, et al. Outcomes by race and etiology of patients with left ventricular systolic dysfunction. Am J Cardiol 2005;96:956–963.

    Article  PubMed  Google Scholar 

  7. Davoodi S, Karimi A, Ahmadi SH, Marzban M, Movahhedi N, Abbasi K, et al. Coronary artery bypass grafting in patients with low ejection fraction: the effect of intra-aortic balloon pump insertion on early outcome. Indian J Med Sci 2008;62:314–322.

    Article  PubMed  Google Scholar 

  8. Davoodi S, Karimi A, Ahmadi SH, Marzban M, Movahhedi N, Abbasi K, et al. Short- and mid-term results of triple-valve surgery with an evaluation of postoperative quality of life. Tex Heart Inst J 2009;36:125–130.

    PubMed  Google Scholar 

  9. Klein JP, Moeschberger ML. Survival analysis: techniques for censored and truncated data. New York: Springer-Verlag; 2003.

    Google Scholar 

  10. Trachiotis GD, Weintraub WS, Johnston TS, Jones EL, Guyton RA, Craver JM. Coronary artery bypass grafting in patients with advanced left ventricular dysfunction. Ann Thorac Surg 1998;66:1632–1639.

    Article  PubMed  CAS  Google Scholar 

  11. Nemec P, Bedanova H, Necas J, Meluzin J, Stetka F, Pokorny P, et al. Coronary artery bypass grafting in patients with left ventricular ejection fraction of 30% or less. Bratisl Lek Listy 2001;102:15–21.

    PubMed  CAS  Google Scholar 

  12. Temporelli PL, Scapellato F, Corrà U, Pistono M, Eleuteri E, Imparato A, et al. Perioperative and postoperative predictors of outcome in patients with low ejection fraction early after coronary artery bypass grafting: the additional value of left ventricular remodeling. Eur J Cardiovasc Prev Rehabil 2008;15:441–447.

    Article  PubMed  Google Scholar 

  13. Karimi A, Ahmadi SH, Davoodi S, Marzban M, Movahhedi N, Abbasi K, et al. Early outcome of coronary artery bypass grafting in patients less than 40 years old comparing with elderly patients. J Teh Univ Heart Ctr 2007;2:95–99.

    Google Scholar 

  14. Argenziano M, Spotnitz HM, Whang W, Bigger JT Jr, Parides M, Rose EA. Risk stratification for coronary bypass surgery in patients with left ventricular dysfunction: analysis of the coronary artery bypass grafting patch trial database. Circulation 1999;100:119–124.

    Google Scholar 

  15. Lazar HL, Fitzgerald C, Gross S, Heeren T, Aldea GS, Shemin RJ. Determinants of length of stay after coronary artery bypass graft surgery. Circulation 1995;92:20–24.

    Google Scholar 

  16. Borzak S, Tisdale JE, Amin NB, Goldberg AD, Frank D, Padhi ID, et al. Atrial fibrillation after bypass surgery: does the arrhythmia or the characteristics of the patients prolong hospital stay? Chest 1998;113:1489–1491.

    Article  PubMed  CAS  Google Scholar 

  17. Song B, Xiao F, Li Y. Value of left ventricular ejection fraction in coronary artery bypass grafting patients. Beijing Da Xue Xue Bao 2007;39:607–609.

    PubMed  Google Scholar 

  18. Campwala SZ, Bansal RC, Wang N, Razzouk A, Pai RG. Mitral regurgitation progression following isolated coronary artery bypass surgery: frequency, risk factors and potential prevention strategies. Eur J Cardiothorac Surg 2006;29:348–354.

    Article  PubMed  Google Scholar 

  19. Herlitz J, Karlson BW, Sjöland H, Albertsson P, Brandrup-Wognsen G, Hartford M, et al. Physical activity, symptoms of chest pain and dyspnea in patients with ischemic heart disease in relation to age before and two years after coronary artery bypass grafting. J Cardiovasc Surg (Torino) 2001;42:165–173.

    CAS  Google Scholar 

  20. Herlitz J, Brandrup-Wognsen G, Caidahl K, Haglid M, Hartford M, Karlson BW, et al. Symptoms of chest pain and dyspnea and factors associated with chest pain and dyspnea 10 years after coronary artery bypass grafting. Am Heart J 2008;156:580–587.

    Article  PubMed  Google Scholar 

  21. Brandrup-Wognsen G, Berggren H, Caidahl K, Karlsson T, Sjöland H, Herlitz J. Predictors for recurrent chest pain and relationship to myocardial ischaemia during long-term followup after coronary artery bypass grafting. Eur J Cardiothorac Surg 1997;12:304–311.

    Article  PubMed  CAS  Google Scholar 

  22. Weber BE, Kapoor WN. Evaluation and outcomes of patients with palpitations. Am J Med 1996;100:138–148.

    Article  PubMed  CAS  Google Scholar 

  23. Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, et al. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article-report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr 2003;16:1091–1110.

    PubMed  Google Scholar 

  24. Antunes MJ. Mild-moderate ischemic mitral regurgitation: should it be treated together with CABG? Eur J Cardiothorac Surg 2006;29:353–354.

    Article  PubMed  Google Scholar 

  25. Glass TA, Mendes de Leon C, Marottoli RA, Berkman LF. Population based study of social and productive activities as predictors of survival among elderly Americans. BMJ 1999;319:478–483.

    Article  PubMed  CAS  Google Scholar 

  26. Mennander A, Angervuori T, Huhtala H, Karhunen P, Tarkka M, Kuukasjärvi P. Positive family history of coronary atherosclerosis and serum triglycerides may predict repeated coronary artery bypass surgery. Scand Cardiovasc J 2005;39:225–228.

    Article  PubMed  Google Scholar 

  27. Harpaz D, Behar S, Rozenman Y, Boyko V, Gottlieb S; Israeli Working Group on Intensive Cardiac Care, Israeli Heart Society. Family history of coronary artery disease and prognosis after first acute myocardial infarction in a national survey. Cardiology 2004;102:140–146.

    Article  PubMed  Google Scholar 

  28. Celermajer DS, Sorensen KE, Bull C, Robinson J, Deanfield JE. Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol 1994;24:1468–1474.

    Article  PubMed  CAS  Google Scholar 

  29. Vita JA, Treasure CB, Nabel EG, McLenachan JM, Fish RD, Yeung AC, et al. Coronary vasomotor response to acetylcholine relates to risk factors for coronary artery disease. Circulation 1990;8:491–497.

    Article  Google Scholar 

  30. Schächinger V, Britten MB, Elsner M, Walter DH, Scharrer I, Zeiher AM. A positive family history of premature coronary artery disease is associated with impaired endotheliumdependent coronary blood flow regulation. Circulation 1999;100:1502–1508.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Saeed Davoodi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Davoodi, S., Sheikhvatan, M., Karimi, A. et al. Outcomes and long-term quality of life of patients with severe left ventricular dysfunction who underwent coronary artery bypass surgery. Gen Thorac Cardiovasc Surg 60, 202–212 (2012). https://doi.org/10.1007/s11748-010-0918-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-010-0918-y

Key words

Navigation