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  • Title: Effect of low left ventricular ejection fractions on the outcome of primary coronary by-pass grafting in end-stage coronary artery disease.
    Author: Christenson JT, Maurice J, Simonet F, Bloch A, Fournet PC, Velebit V, Schmuziger M.
    Journal: J Cardiovasc Surg (Torino); 1995 Feb; 36(1):45-51. PubMed ID: 7721925.
    Abstract:
    Advanced ischemic heart disease (HID) with very low left ventricular ejection fraction (LVEF), pulmonary hypertension (PHT) with or/without left ventricular aneurysm (LVA) are criteria for defining end-stage coronary artery disease (ESCAD). Coronary artery by-pass grafting is often denied to these patients. Between January 1990 and December 1993, 91 patients with ESCAD, significant 2 or 3-vessel disease (stenosis > or = 70%) and LVEF < or = 25% underwent primary CABG at our institutions. The mean age was 62.5 +/- 8.0 years (41-81), 89% were men. Eighty-one patients were in preoperative NYHA (New York Heart Association) functional class 3 and 4. Mean LVEF was 21.3 +/- 3.8% (10-25). Mitral regurgitation (MR) was present in 39/91 (43%). The systolic pulmonary artery pressure (PAP) was 33.2 +/- 17.1 mmHg (11-75) and the wedge pressure was 19.0 +/- 10.8 mmHg (5-47). Twenty-two patients had significant PHT with a systolic PAP > or = 40 mmHg. The overall perioperative mortality was 14.3% (13/91). Low postoperative cardiac output occurred in 33 patients, requiring intraaortic balloon support in 13. Gastrointestinal complications occurred in 6 patients and neurological events in one. Fifteen patients had additional left ventricular aneurysm repair. There was a good correlation between LVEF and PAP (r = 0.782). Surprisingly, in a subset of patients with preoperative PHT and LVEF < or = 25% the mortality rate was only 4.6% (1/22). Other perioperative complications did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)
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