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J Thorac Cardiovasc Surg 1996;111:1001-1012
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH AN EJECTION FRACTION OF TWENTY PERCENT OR LESS

From the Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, Ala.

Received for publication June 1, 1994 Accepted for publication July 20, 1995. Address for reprints: Tej K. Kaul, MD, 817 Princeton Avenue, SW, Suite 300, Birmingham, AL 35211.

Abstract

Over a 7-year period, 5.8% (n = 210) of patients who underwent coronary artery bypass grafting at our institution had severely impaired global left ventricular function with an ejection fraction of 20% or less. Mean age at operation was 66 years (±0.7; standard error), and 76% of patients were male. Primary indications for operation were unstable angina (73 patients, 35%), return of symptoms with previous bypass grafting (41 patients, 20%), congestive heart failure with reversible ischemia (55 patients, 26%), and recurrent ventricular arrhythmias (41 patients, 20%). Overall, actuarial survival (n = 210) was 82%, 79%, and 73% at 1, 2, and 5 years. Risk of death was highest early after the operation, and then declined rapidly to a constant level. Patients who did not receive retrograde coronary sinus cardioplegia (p = 0.05), older patients (p = 0.004), and those with preoperative ventricular arrhythmias (p = 0.003) or renal failure (p < 0.0001) had an increased risk of death early after operation. Patients with congestive symptoms and those requiring extensive or redo bypass grafting (p = 0.02) were found to be at an increased risk of death throughout the follow-up period. When the number of distal anastomoses performed increased, survival was found to decrease (p < 0.003), and to a greater extent in women than in men (p = 0.02). Of the four primary indications for operation, unstable angina yielded the highest risk-adjusted survival. Successful results after surgical revascularization in patients with severe impairment of ventricular function can be achieved by careful patient selection and management. (J THORACCARDIOVASCSURG1996;111:1001-12)

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