Coronary Artery Bypass Graft in Patient with Advanced Left Ventricular Dysfunction

Jung, Jong Pil; Kim, Seung Woo; Shin, Je Kyoun

Abstract

BACKGROUND: Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. MATERIAL AND METHOD: Clinical data of 31(4.1%) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98%) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84%) and first degree of Rentrop classification(16 cases, 52%) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9+/-0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7+/-3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9+/-1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5%. Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5+/-11.6%, P<0.001) as compared with preoperative left ventricular ejection fraction(25.3+/-2.3%). The follow up period of out patient was 25.3 months.
CONCLUSION
In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.