Decision-Making in End-Stage Coronary Artery Disease: Revascularization or Heart Transplantation?
Section snippets
Material and Methods
In a prospective study from April 1986 until December 1994, 514 patients with CAD and LVEF between 0.10 and 0.30 were examined and prepared for CABG. Patients with an aneurysm of the left ventricle, valvular heart disease, ventricular septal defect after myocardial infarction, or cardiomyopathy were not included in this group. Two hundred twenty-five of the patients were referred to the German Heart Institute Berlin as possible HTx candidates. The most important criteria for bypass grafting
Results
Operative mortality was 7.1% (16 of 225) in the CABG group. One patient died of septicemia and multiple organ failure. Fifteen patients died of early postoperative low cardiac output syndrome. Intraaortic balloon pumps were implanted in 46 of 225 patients (20.4%) to aid weaning from heart-lung bypass; 29 (63.0%) of these 46 were successfully explanted preoperatively. In 2 patients the intraaortic balloon pump had to be implanted through the ascending aorta because of peripheral
Comment
Clinical characteristics and angiographic features associated with increased OPM after CABG on patients with normal or mildly reduced ventricular function were first described in the medical literature more than a decade ago [12, 13]. At that time LVEF was considered the most important predictor of survival after CABG. In recent years parallel improvements in surgical procedures and medical management in intensive and outpatient care have lead to increased success in performing CABG on patients
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2010, American Journal of CardiologyCitation Excerpt :These results indicate that revascularization of hibernating myocardium can improve prognosis along with relief of symptoms in patients with severe SHF. An earlier uncontrolled single-center study compared the long-term survival of patients who underwent CABG to that of patients who underwent cardiac transplantation.69 Operative mortality for CABG was 7.2% and for cardiac transplantation was 18.2%.
Alternatives to transplantation in the surgical therapy for heart failure
2009, European Journal of Cardio-thoracic Surgery