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. 1998;25(2):125–129.

Coronary artery bypass grafting in patients with profound ventricular dysfunction.

F J Baumgartner 1, B O Omari 1, S Goldberg 1, A B Pandya 1, A B Pandya 1, A M Daland 1, S Sun 1, J C Millikin 1
PMCID: PMC325524  PMID: 9654657

Abstract

Patients with severe ventricular dysfunction make up a special subset of patients who undergo coronary artery bypass procedures. For these patients, the risk associated with the bypass procedure is relatively high, but the opportunity-for-survival benefit is also greater. We studied 61 consecutive coronary artery bypass patients with preoperative ejection fractions < or = 25%, and further compared several subgroups: Group I (n = 30) ejection fractions ranged from 21% to 25%; Group II (n = 23) ejection fractions ranged from 16% to 20.9%; and Group III (n = 8) ejection fractions ranged from 10% to 15.9%. The overall mortality rate was 8% (5/61), with no deaths in Group III. The 41% (25/61) of patients who received left internal mammary artery conduits experienced a higher mortality rate, yet it did not differ significantly from that of patients who received only saphenous vein conduits. Intraaortic balloon pumps were placed in 48% (29/61) of the patients, with a progressively higher incidence in patients with poorer ventricular function (P < 0.05). Most intraaortic balloon pumps (59%) were placed intraoperatively. Two patients underwent placement of left ventricular assist devices, and 1 of these survived. Coronary artery bypass grafting in patients with poor ventricular function carries a substantial, but acceptable, mortality risk. Use of the left internal mammary artery did not improve perioperative mortality, and may have a negative impact in the early postoperative period. Intraaortic balloon pump use was most common in those patients with the worst ventricular function. Prophylactic intraaortic balloon pump use may be justified in candidates with ejection fractions < 20%.

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Selected References

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  1. Alderman E. L., Fisher L. D., Litwin P., Kaiser G. C., Myers W. O., Maynard C., Levine F., Schloss M. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983 Oct;68(4):785–795. doi: 10.1161/01.cir.68.4.785. [DOI] [PubMed] [Google Scholar]
  2. Christakis G. T., Weisel R. D., Fremes S. E., Ivanov J., David T. E., Goldman B. S., Salerno T. A. Coronary artery bypass grafting in patients with poor ventricular function. Cardiovascular Surgeons of the University of Toronto. J Thorac Cardiovasc Surg. 1992 Jun;103(6):1083–1092. [PubMed] [Google Scholar]
  3. Coles J. G., Del Campo C., Ahmed S. N., Corpus R., MacDonald A. C., Goldbach M. M., Coles J. C. Improved long-term survival following myocardial revascularization in patients with severe left ventricular dysfunction. J Thorac Cardiovasc Surg. 1981 Jun;81(6):846–850. [PubMed] [Google Scholar]
  4. Cosgrove D. M., Loop F. D., Lytle B. W., Baillot R., Gill C. C., Golding L. A., Taylor P. C., Goormastic M. Primary myocardial revascularization. Trends in surgical mortality. J Thorac Cardiovasc Surg. 1984 Nov;88(5 Pt 1):673–684. [PubMed] [Google Scholar]
  5. Elami A., Uretzky G., Appelbaum A., Gotsman M. S., Borman J. B. Improved functional results following myocardial revascularization in patients with left ventricular dysfunction. J Cardiovasc Surg (Torino) 1987 Jan-Feb;28(1):61–67. [PubMed] [Google Scholar]
  6. Faulkner S. L., Stoney W. S., Alford W. C., Thomas C. S., Burrus G. R., Frist R. A., Page H. L. Ischemic cardiomyopathy: medical versus surgical treatment. J Thorac Cardiovasc Surg. 1977 Jul;74(1):77–82. [PubMed] [Google Scholar]
  7. Hochberg M. S., Parsonnet V., Gielchinsky I., Hussain S. M. Coronary artery bypass grafting in patients with ejection fractions below forty percent. Early and late results in 466 patients. J Thorac Cardiovasc Surg. 1983 Oct;86(4):519–527. [PubMed] [Google Scholar]
  8. Holmes D. R., Jr, Davis K. B., Mock M. B., Fisher L. D., Gersh B. J., Killip T., 3rd, Pettinger M. The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: a report from the Coronary Artery Surgery Study. Circulation. 1986 Jun;73(6):1254–1263. doi: 10.1161/01.cir.73.6.1254. [DOI] [PubMed] [Google Scholar]
  9. Hung J., Kelly D. T., Baird D. K., Hendel P. N., Leckie B. D., Grant A. F., Uren R. F. Aorta-coronary bypass grafting in patients with severe left ventricular dysfunction. J Thorac Cardiovasc Surg. 1980 May;79(5):718–723. [PubMed] [Google Scholar]
  10. Isom O. W., Spencer F. C., Glassman E., Dembrow J. M., Pasternack B. S. Long-term survival following coronary bypass surgery in patients with significant impairment of left ventricular function. Circulation. 1975 Aug;52(2 Suppl):I141–I147. [PubMed] [Google Scholar]
  11. Johnstone D. E., Adelman A. G., Weingert M., Huckell V. F., Goldman B. S. Aortocoronary bypass in patients with severe left ventricular dysfunction. Can J Surg. 1980 Mar;23(2):127–131. [PubMed] [Google Scholar]
  12. Kaiser G. C., Davis K. B., Fisher L. D., Myers W. O., Foster E. D., Passamani E. R., Gillespie M. J. Survival following coronary artery bypass grafting in patients with severe angina pectoris (CASS). An observational study. J Thorac Cardiovasc Surg. 1985 Apr;89(4):513–524. [PubMed] [Google Scholar]
  13. Kirklin J. W., Blackstone E. H., Rogers W. J. Bishop Lecture. The plights of the invasive treatment of ischemic heart disease. J Am Coll Cardiol. 1985 Jan;5(1):158–167. doi: 10.1016/s0735-1097(85)80099-1. [DOI] [PubMed] [Google Scholar]
  14. Lawrie G. M., Morris G. C., Jr, Baron A., Norton J., Glaeser D. H. Determinants of survival 10 to 14 years after coronary bypass: analysis of preoperative variables in 1,448 patients. Ann Thorac Surg. 1987 Aug;44(2):180–185. doi: 10.1016/s0003-4975(10)62037-1. [DOI] [PubMed] [Google Scholar]
  15. Takeishi Y., Tono-oka I., Kubota I., Ikeda K., Masakane I., Chiba J., Abe S., Tsuiki K., Komatani A., Yamaguchi I. Functional recovery of hibernating myocardium after coronary bypass surgery: does it coincide with improvement in perfusion? Am Heart J. 1991 Sep;122(3 Pt 1):665–670. doi: 10.1016/0002-8703(91)90509-g. [DOI] [PubMed] [Google Scholar]
  16. Wechsler A. S., Junod F. L. Coronary bypass grafting in patients with chronic congestive heart failure. Circulation. 1989 Jun;79(6 Pt 2):I92–I96. [PubMed] [Google Scholar]
  17. Yatteau R. F., Peter R. H., Behar V. S., Bartel A. G., Rosati R. A., Kong Y. Ischemic cardiomyopathy: the myopathy of coronary artery disease. Natural history and results of medical versus surgical treatment. Am J Cardiol. 1974 Oct 3;34(5):520–525. doi: 10.1016/0002-9149(74)90121-0. [DOI] [PubMed] [Google Scholar]

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