Original article
Cardiovascular
Results and Predictors of Early and Late Outcome of Coronary Artery Bypass Grafting in Patients With Severely Depressed Left Ventricular Function

https://doi.org/10.1016/j.athoracsur.2007.04.117Get rights and content

Background

Coronary artery bypass grafting (CABG) is a well-accepted therapeutic approach in patients with symptomatic multivessel coronary artery disease and severely depressed left ventricular function. However, the potential impact of off-pump CABG in this group of patients remains unknown. In addition, there are only scarce data regarding long-term survival and its predictors in this patient population.

Methods

We retrospectively analyzed prospectively collected data of 2,725 consecutive patients (mean age, 65 ± 11 years; 843 (31%) female) undergoing CABG between January 1998 and December 2005 (ejection fraction [EF] ≤ 0.30; n = 495, 18%). Outcome measures included hospital mortality, major complications, and long-term survival. Multivariate analysis was performed to identify predictors of hospital mortality and late survival. Subgroup analysis for patients with EF less than or equal to 0.30 undergoing conventional CABG (n = 424, 86%) versus off-pump CABG (n = 71, 14%) was performed.

Results

Hospital mortality was 1.8% (EF ≤ 0.30, 3.6%; EF > 0.30, 1.4%; p = 0.002). Off-pump CABG did not have an impact on operative mortality (on-pump, 4%; off-pump, 3%; p = 0.509). Ejection fraction of 0.30 or less was not an independent risk factor of hospital mortality but predicted respiratory failure (odds ratio [OR] = 2.3) and sepsis (OR, 1.4). Long-term survival was significantly decreased in patients with EF of 0.30 or less: 1-year and 5-year survival 88% ± 1.5% and 75% ± 2.2% versus 96% ± 0.4% and 81% ± 1.2%, respectively (p = 0.001). Reoperation (OR, 6.9), peripheral vascular disease (OR, 3.2), chronic obstructive pulmonary disease (OR, 3.0), congestive heart failure (OR, 2.7), and female sex (OR, 2.1) were independent predictors of long-term survival.

Conclusions

Excellent results after CABG can be expected in patients with EF of 0.30 or less, with minimal increase in mortality and acceptable postoperative morbidity. Long-term survival remains limited, but recent results are substantially better than historical reports. Careful preoperative patient selection and perioperative management are essential in these patients undergoing CABG.

Section snippets

Study Population

We analyzed a series of 2,725 patients undergoing isolated CABG procedures at the Mount Sinai Medical Center between January 1998 and December 2005. Data were prospectively collected and analyzed retrospectively.

The study group was determined by the preoperative EF. Patients with an EF less than or equal to 0.30 formed the study group, whereas patients with an EF greater than 0.30 served as the control group. Patients undergoing reoperations or emergent procedures were included in this

Demographic Data and Preoperative Risk Factors

The median age in the overall patient population was 66 years (interquartile range, 58–73 years), and 69% (n = 1,882) of patients were male. Severely depressed LV function (EF ≤ 0.30) was present in 495 (18%) patients.

There were significant differences in preoperative comorbidity between patients with EF of 0.30 or less and those with EF greater than 0.30 (Table 1). Patients with EF of 0.30 or less were more likely to present with congestive heart failure (p < 0.001), a history of myocardial

Comment

In this observational study, we report our experience in a large and contemporary series of patients with severely depressed LV function undergoing CABG. The main findings of this study include very low operative mortality, which declined across the study period despite a statistically significant increase in the percentage of patients with high predicted mortality risk by logistic EuroSCORE. We show that severely depressed LV function does not appear to be an independent predictor of early

References (28)

  • S.M. Scott et al.

    VA study of unstable angina: 10-year results show duration of surgical advantage for patients with impaired ejection fraction

    Circulation

    (1994)
  • E. Passamani et al.

    A randomized trial of coronary artery bypass surgerySurvival of patients with a low ejection fraction

    N Engl J Med

    (1985)
  • T.B. Ferguson et al.

    A decade of change–risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990–1999: a report from the STS National Database Committee and the Duke Clinical Research Institute

    Ann Thorac Surg

    (2002)
  • K.A. Eagle et al.

    ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery)

    Circulation

    (2004)
  • Cited by (58)

    • Meta-Analysis of Relation Between Left Ventricular Dysfunction and Outcomes After Transcatheter Mitral Edge-to-Edge Repair

      2022, American Journal of Cardiology
      Citation Excerpt :

      Although left ventricular (LV) ejection fraction (LVEF) is a known predictor of adverse outcomes after cardiac and noncardiac surgery, randomized controlled trials (RCTs) showed no impact of LV dysfunction on transcatheter edge-to-edge repair (TEER) outcomes.1–5

    View all citing articles on Scopus
    View full text