CARDIAC PAPERSMyocardial revascularization for severe left ventricular dysfunction. Factors influencing early and late survival
Section snippets
Patients
Between 16 November 1989 and 21 November 1994, 1654 patients underwent isolated coronary bypass grafting at the authors' hospital. Among these, 102 patients (6.2%) were identified as having a preoperative left ventricular ejection fraction of ⩽0.35 by angiographic ventriculography or gated blood pool scintigraphy. In order to be considered as candidates for bypass they either had to have symptoms of angina pectoris or undergo a thallium-201 perfusion myocardial scintiscan that demonstrated
Overall results
Nine patients died during their hospital stay, an operative mortality rate of 8.8%. The immediate cause of death was cardiogenic shock in seven patients, intractable ventricular arrhythmia in one patient and pulmonary embolism in one. The mean interval between death and the procedure was 13.7(5.0) (range 1–50) days. No patient died during surgery. The main nonlethal complications are listed in Table 3.
Univariate analysis of factors influencing operative mortality
Significant operative risk factors are listed in Table 4. Among the preoperative risk factors,
Discussion
The necessity for preoperative intra-aortic balloon counterpulsation is a well-known risk factor [9]. The present study corroborates the results of Christakis et al. [10] who stated that the use of an intra-aortic balloon pump before surgery did not decrease the risk of operative death but indicated the patients at highest risk. The authors' patients who required preoperative intra-aortic balloon counterpulsation had poorer results probably because they had suffered more perioperative ischaemic
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