Coronary surgery with non-cardioplegic methods in patients with advanced left ventricular dysfunction: immediate and long term results

Abstract

Objective: To evaluate perioperative results and long term survival in patients with severe left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) using non-cardioplegic methods. Methods: From April 1990 through December 1999, 4100 consecutive patients underwent isolated CABG using hypothermic ventricular fibrillation. Of these, 141 (3.4%) had severe LV dysfunction (ejection fraction < 30%). Mean age was 58.3 (9.6) years. 64 patients (45.4%) were in Canadian Cardiovascular Society class III or IV and 16 (11.3%) were subjected to urgent or emergent surgery. A previous myocardial infarction was recorded in 127 (90.1%). The majority (89.4%) had triple vessel and 26 (18.4%) had left main disease. The mean number of grafts per patient was 3.1. At least one internal thoracic artery was used in all patients and 21 (14.8%) had bilateral internal thoracic artery grafts (1.2 arterial grafts per patient). Results: Perioperative mortality was 2.8% (4 patients) and the incidence of acute myocardial infarction 2.8%. 50 (35.5%) patients required inotropes but only 16 (11.3%) required it for longer than 24 hours; 5 patients (3.5%) needed mechanical support. The incidence of renal failure was 3.5%. Mean duration of hospital stay was 9.6 (8.3) days. Follow up was 95% complete and extended for a mean of 57 (30) months. Late mortality was 11.5%. Actuarial survival rates at 1, 3, and 5 years were 96%, 91%, and 86%, respectively. Conclusions: Non-cardioplegic techniques are safe and effective in preserving the myocardium during CABG in patients with coronary artery disease and poor LV function, with low operative mortality and morbidity, and encouraging medium to long term survival rates.

Is severely left ventricular dysfunction a predictor of early outcomes in patients with coronary artery bypass graft?

“…Magee et al 23 demonstrated CPB in their study as a predictor of in-hospital mortality in patients who underwent CABG. Antunes et al 24 in their study showed that perfusion time is longer in patients with left ventricular dysfunction. Perfusion time in our study was longer in patients with EF≤35% compared with those without, and in this study we actuated perfusion time (OR=1.014, CI=1.006 to 1.027) as a predictor of mortality in patients with EF≤35%.…”

Nontransplant surgical options for congestive heart failure

“…In a group of 141 consecutive cases with EF less than 30% (12%-29%), submitted to isolated coronary surgery using noncardioplegic techniques, we [19] observed a 2.8% hospital mortality and an actuarial survival of 96% and 86% at 1 and 5 years, respectively. In the immediate postoperative period, less than 35% of the patients required inotropic support for over 24 hours, and aortic counterpulsation was used in only 3.5%.…”

“…Although the experimental results are inspiring [40][41][42], clinical results have yet not been made available and trials are still being carried out. [3] 0.24 0 74 Mitral insufficiency Calafiore et al [11] 0.27 4.1 78 Gummert et al [12] 0.25 6.1 86 66 Bishay et al [13] 0.28 2.3 88 72 Rothemburger et al [15] 0.23 91 77 Coronary bypass Antunes et al [19] ? …”

Coronary Bypass Surgery for Patients with Chronic Poor Preoperative Left Ventricular Function (EF<30%): 5-year Follow-up

“…26 Within the last decade mortality rates under 5% are common. 3,7,13,[26][27][28][29] Differences in surgical series may reflect patient selection. 30,31 Nevertheless, the incidence of perioperative myocardial injury is low (i.e.…”

“…<2%), in series with low mortality. 3,7,13,19,26,28 Hence, attention to myocardial protection is critical. There appears to be no significant difference between the different techniques of myocardial protection.…”