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J Thorac Cardiovasc Surg 1995;110:1013-1022
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

THE ROLE OF CORONARY REVASCULARIZATION IN RECIPIENTS OF AN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

David M. Shahian, MD, Warren A. Williamson, MD, Ferdinand J. Venditti, Jr., MD, David T. Martin, MD, Jonathan R. Ellis, MD


Burlington, Mass.

From the Department of Thoracic and Cardiovascular Surgery and the Section of Cardiology, Lahey Clinic Medical Center, Burlington, Mass.

Received for publication June 15, 1994. Accepted for publication Dec. 29, 1994. Address for reprints: David M. Shahian, MD, Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, 41 Mall Rd., Burlington, MA 01805.

Abstract

The impact of adjuvant coronary revascularization was studied in a group of 138 recipients of an implantable cardioverter-defibrillator, all of whom had ischemic heart disease as the cause of their arrhythmias. Patients chosen for revascularization had more severe anatomic, symptomatic, or physiologic evidence of active ischemia. There were no operative deaths among 23 patients who actually underwent coronary artery bypass combined with cardioverter-defibrillator implantation; however, operative mortality by the intention-to-treat principle was 8% (2/25). Total cardiac survival was better for patients who underwent revascularization than for those patients who had "high-risk"characteristics and did not undergo revascularization. Stratified subgroup analysis demonstrated significant survival advantages favoring revascularization in patients with three-vessel or left main coronary artery disease, class III or IV angina, and an ejection fraction greater than 25%. Multivariate analysis revealed that low ejection fraction and left main coronary artery disease were independent predictors of decreased survival. (J THORACCARDIOVASCSURG1995;110:1013-22)






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Copyright © 1995 by The American Association for Thoracic Surgery.