Abstract
Background and Objectives: Patients with low ejection fraction (EF) are at high risk for postoperative complication and mortality. Our Aim: outcome & effect of coronary artery bypass graft surgery on left ventricular systolic function.
Materials and Methods: This is a descriptive study. Between January 2017 to August 2019, 51 consecutive patients underwent isolated CABG at the Rajarajeshwari medical college and Hospital. Of these, 51 had echocardiographic assessment of LV function, preoperatively with respect to patient characteristics, risk factors, and preoperative two dimension echocardiography (2D ECHO). Depending on findings of 2D ECHO patients were divided into three groups: in Group 1, we included patients with EF 30%–35%, Group 2 comprised patients with EF of 25%–30%, and Group 3 consisted of patients with EF. Appropriate investigations were done.
Results: Hospital mortality rate in present series was 9.8%. Mean grafts were 3.02 per patient. Fourteen (40%) patient had a postoperative complication. EF improved in 78% of patients. Canadian Cardiovascular Society Angina class improved in 42% of patients.
Conclusion: We have shown that cardiac surgery provides long-term cardiac-death-free survival benefit in patients of all subsets of LV function, including poor and very poor LV function.
Keywords: CABG (Coronary artery bypass surgery), low ejection fraction (EF), stunned myocardium.
References
- Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;62:e147-239. 10.1016/j.jacc.2013.05.019 [PubMed] [CrossRef] [Google Scholar]
- Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;124:2610-42. 1161/CIR.0b013e31823b5fee [PubMed] [CrossRef] [Google Scholar]
- Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011;124: 2574-609. 10.1161/CIR.0b013e31823a 5596 [PubMed] [CrossRef] [Google Scholar]
- Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012;126:e354-471. 10.1161/CIR. 0b013e 318277d6a0 [PubMed] [CrossRef] [Google Scholar]
- Caracciolo EA, Davis KB, Sopko G, et al. Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease. Long-term CASS experience. Circulation 1995; 91:2335-44. 10.1161/01.CIR.91.9.2335 [PubMed] [CrossRef] [Google Scholar]
- Kunadian V, Zaman A, Qiu W. Revascularization among patients with severe left ventricular dysfunction: A meta-analysis of observational studies. Eur J Heart Fail 2011;13:773-84.
- Elefteriades JA, Tolis G Jr., Levi E, Mills LK, Zaret BL. Coronary artery bypass grafting in severe left ventricular dysfunction: Excellent survival with improved ejection fraction and functional state. J Am Coll Cardiol 1993;22:1411-7.
- Scott SM, Deupree RH, Sharma GV, Luchi RJ. VA Study of Unstable Angina 10-year results show duration of surgical advantage for patients with impaired ejection fraction. Circulation 1994;90(5 Pt 2):II120-3.
- Christakis GT, Weisel RD, Fremes SE, Ivanov J, David TE, Goldman BS, et al. Coronary artery bypass grafting in patients with poor ventricular function. Cardiovascular Surgeons of the University of Toronto. J Thorac Cardiovasc Surg 1992;103:1083-91.
- Carr JA, Haithcock BE, Paone G, Bernabei AF, Silverman NA. Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction. Ann Thorac Surg 2002;74:1531-6.
- Rastan AJ, Bittner HB, Gummert JF, Walther T, Schewick CV, Girdauskas E, et al. On-pump beating heart versus off-pump coronary artery bypass surgery-evidence of pump-induced myocardial injury. Eur J Cardiothorac Surg 2005;27:1057-64.
- Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco‑Batlles D, Brunken RC, et al. Long‑term survival of patients with coronary artery disease and left ventricular dysfunction: Implications for the role of myocardial viability assessment in management decisions. J Thorac Cardiovasc Surg [1998;116:997-1004].
Corresponding Author
Dr Rajiv Girdhar
Assistant Professor in Cardiology Dept., Rajarajeswari Medical College & Hospital
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.17
