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J Thorac Cardiovasc Surg 1996;111:998-1000
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Editorial on "Coronary Artery Bypass Grafting in Patients With an Ejection Fraction of Twenty Percent or Less"

From the Medical College of Virginia, Richmond, Va.

Received for publication June 1, 1994 Accepted for publication July 20, 1995. Address for reprints: Andrew S. Wechsler, MD, Medical College of Virginia, MCV Station, P.O. Box 980645, Richmond, VA 23298-0645.

Kaul and his coauthors [see page 1001] relate their experience with a group of patients having low ejection fractions on whom they performed coronary artery bypass grafting. Careful statistics document early and late survival, expressed as hazard probabilities. On the basis of these results, the authors attribute enhanced success to the use of a combination of antegrade and retrograde cardioplegia, performing fewer bypass grafts (shorter crossclamp times), and the absence of preoperative ventricular arrhythmias as a primary indication for operation. The patients in their study had complex problems and had several different indications for operations. Simultaneous and independent events may have influenced outcome, independent of the factors identified. These include experience, change in operative technique, inadvertent changes in operative selection, and other factors that constitute risks inherent in all retrospective studies. As such, it is uncertain whether similar modifications in operative technique by other groups are likely to yield the same results. Nonetheless, this study stimulated me to think about operations on patients with low ejection fractions and to reexamine the issues inherent in such a designation and study focus.

Why focus on results in patients with low ejection fractions? Presumably, the answer is determined from studies indicating the high risk of operation juxtaposed against the poor outcomes in patients treated medically. To some extent, surgeons weigh their technical expertise by survival in patients in whom the risk is high, are challenged by high risk, and are appropriately proud of good results. A low ejection fraction is generally assumed to be a surrogate for . . . [Full Text of this Article]

Related Article

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

Tej K. Kaul, Arvind K. Agnihotri, Barry L. Fields, Lee S. Riggins, David A. Wyatt, and Christopher R. Jones
J. Thorac. Cardiovasc. Surg. 1996 111: 1001-1012. [Abstract] [Full Text]

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