Elsevier

Cardiovascular Surgery

Volume 4, Issue 5, October 1996, Pages 607-616
Cardiovascular Surgery

CARDIAC PAPERS
Myocardial revascularization for severe left ventricular dysfunction. Factors influencing early and late survival

https://doi.org/10.1016/0967-2109(95)00141-7Get rights and content

Abstract

The results of coronary bypass surgery have been assessed in 102 patients with severe left ventricular dysfunction who had a preoperative left ventricular ejection fraction of ⩽0.35 (mean(s.e.m.) 0.29 (0.01)). Independent risk factors influencing operative mortality were obesity (P = 0.0290) and the need for preoperative intra-aortic balloon counterpulsation (P = 0.0010). Cox regression analysis using as its end-point ‘cardiac-related death’ demonstrated three variables; the need for preoperative intra-aortic balloon counterpulsation (P = 0.001), advanced age (P = 0.011), and obesity (P = 0.036). In a subset of 43 patients who did not have these risk factors, the 4-year cardiac-related death rate was 95.1 (3.4)%. The operative mortality and long-term survival can be expected to be satisfactory in patients with severe left ventricular dysfunction, provided they have a viable myocardium rather than myocardial fibrosis.

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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