Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction

Carr, John Alfred; Haithcock, Benjamin E.; Paone, Gaetano; Bernabei, Alvise; Silverman, Norman A.

doi:10.1016/s0003-4975(02)03944-9

Cited by 70 publications

(72 citation statements)

References 23 publications

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“…6,7) Recent studies have reported early postoperative mortality rates of 1.7%-11% in patients with LVD. 1,[6][7][8][9][10][11][12][13][14][15][16][17] The operative mortality rate in this study (2.5%) was similar to that reported in other studies, indicating the safety of the off-pump technique for patients with LVD.…”

Section: Discussionsupporting

confidence: 85%

“…In the present study, CABG resulted in signifi cant improvements in LVEF and all left ventricular dimensions and volumes. Carr and colleagues 13) found ongoing improvement in LVEF during follow-up. They reported that the preoperative mean LVEF of 18 ± 3% improved to 36 ± 14% at 4-6 years after surgery, and suggested that this improvement was due to a decrease in left ventricular systolic diameter despite a lack of change in diastolic diameter.…”

Section: Early Postoperative and Follow-up Echocardiographic Outcomesmentioning

confidence: 91%

“…1,[7][8][9]11,13,14,25) Attaran and colleagues 20) reported no signifi cant differences in long-term survival between off-pump and on-pump CABG, with 5-and 10-year survival rates after off-pump CABG of 75.4% and 71.8%, respectively. Their survival rates were similar to those found in the present study.…”

Section: Early Postoperative and Follow-up Echocardiographic Outcomesmentioning

confidence: 99%

“…Patients who undergo incomplete revascularization have worse outcomes after CABG than those who undergo complete revascularization. 22) Several studies have documented that appropriate myocardial revascularization in patients with LVD improves their quality of life, 23) left ventricular contractility, 13) LVEF, 14) and New York Heart Association functional class. 24) However, a lower number of anastomoses was reported in also identifi ed renal dysfunction as the strongest independent predictor of mortality.…”

Section: Early Postoperative and Follow-up Echocardiographic Outcomesmentioning

confidence: 99%

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Long-Term Outcomes after Off-Pump Coronary Artery Bypass Grafting in Left Ventricular Dysfunction

Fukui

Tabata

Takanashi

2014

ATCS

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Purpose:We assessed the long-term clinical, angiographic, and echocardiographic outcomes of patients with left ventricular dysfunction (ejection fraction ≤40%) who underwent isolated off-pump coronary artery bypass grafting. Methods: One hundred sixty one patients were included. Mean age was 67.2 ± 11.4 years, and 20 patients (12.4%) were female. Eighty-eight patients (54.7%) were New York Heart Association functional class 3 or 4. Early postoperative and follow-up angiography and echocardiography fi ndings were analyzed, and mid-term survival rates (mean follow-up 40.7 ± 25.6 months) were calculated. Results: Mean number of distal anastomoses was 4.4 ± 1.3. Bilateral internal thoracic artery grafts were used in 84.5% of patients. Operative mortality was 2.5%. Early patency rate of anastomoses was 98.3%. Early postoperative ejection fraction improved from 33.1 ± 5.6% preoperatively to 36.9 ± 9.5% (p <0.001). Seven-year survival rate was 73.9 ± 5.3%, and freedom from cardiac events rate was 68.5 ± 5.2%. One-year patency rate of anastomoses was 85.8%. Follow-up ejection fraction was 39.1 ± 10.7% ( p <0.001). Conclusions: Early and long-term outcomes of off-pump coronary artery bypass grafting in patients with left ventricular dysfunction were favorable, including early postoperative and follow-up patency rates of anastomoses and echocardiographic recovery of ejection fraction.

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Section: Discussionsupporting

confidence: 85%

Section: Early Postoperative and Follow-up Echocardiographic Outcomesmentioning

confidence: 91%

Section: Early Postoperative and Follow-up Echocardiographic Outcomesmentioning

confidence: 99%

Section: Early Postoperative and Follow-up Echocardiographic Outcomesmentioning

confidence: 99%

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Long-Term Outcomes after Off-Pump Coronary Artery Bypass Grafting in Left Ventricular Dysfunction

Fukui

Tabata

Takanashi

2014

ATCS

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“…The steep operative mortality in the LEF group (13.5%) was considerably higher compared to the published mortality of non-reoperative (first time) cardiac surgery patients with low LVEF (5.6% to 11%) (13)(14)(15) and to the previously published operative mortality in all re-AVR patients (4.5% to 5.1%) (8,9), to which the 3.2% mortality of our re-AVR HEF group compares favorably. The contrasting outcomes of re-AVR LEF patients to both HEF and historic groups stress the increased risk conferred by the presence of low ventricular contractility and a prior sternotomy.…”

Section: Discussioncontrasting

confidence: 57%

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Yammine

Val

Ejiofor

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Patient comorbidities play a pivotal role in the surgical outcomes of reoperative aortic valve replacement (re-AVR). Low left ventricular ejection fraction (LVEF) and renal insufficiency (Cr >2 mg/dL) are known independent surgical risk factors. Improved preoperative risk assessment can help determine the best therapeutic approach. We hypothesize that re-AVR patients with low LVEF and concomitant renal insufficiency have a prohibitive surgical risk and may benefit from transcatheter AVR (TAVR).Methods: From January 2002 to March 2013, we reviewed 232 patients who underwent isolated re-AVR.Patients older than 80 years were excluded to adjust for unobserved frailty. We identified 37 patients with a ≤35% LVEF (low ejection fraction group-LEF) and 195 patients with >35% LVEF (High ejection fraction group-HEF).Results: The mean age was 68.4±11.5 years and there were more females (86.5% versus 64.1%, P=0.007) in the LEF group. The prevalence of renal insufficiency was higher in LEF patients (27% versus 5.6%, P=0.001).Higher operative mortality (13.5% versus 3.1%, P=0.018) was observed in the LEF group. Stroke rates were similar in both groups (8.1% versus 4.1%, P=0.39). Unadjusted cumulative survival was significantly lower in LEF patients (6.6 years, 95% CI: 5.2-8.0, versus 9.7 years, 95% CI: 8.9-10.4, P=0.024). In patients without renal insufficiency, LEF and HEF had similar survival (8.3 years, 95% CI: 7.1-9.5, versus 9.9 years, 95% CI:9.1-10.6, P=0.90). Contrarily, in patients with renal insufficiency, LEF led to a significantly lower survival (1.1 years, 95% CI: 0.1-2.0, versus 4.8 years, 95% CI: 2.2-7.3, P=0.050). Adjusted survival analysis revealed elevations in baseline creatinine (HR =4.28, P<0.001) and LEF (HR =5.33, P=0.041) as significant predictors of long-term survival, with a significant interaction between these comorbidities (HR =7.28, P<0.001). Conclusions:In re-AVR patients, low LVEF (≤35%) is associated with increased operative mortality.Concomitant renal insufficiency in these patients results in a prohibitively low cumulative survival. These reoperative surgical outcomes should warrant expanding the role of TAVR for reoperative patients with LEF and renal impairment.

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The Concept of Heart Failure: Chronic Diseases Accompanied by an Attack of Acute Exacerbation

Kato

2017

Therapeutic Strategies for Heart Failure

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Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction

Cited by 70 publications

References 23 publications

Long-Term Outcomes after Off-Pump Coronary Artery Bypass Grafting in Left Ventricular Dysfunction

Long-Term Outcomes after Off-Pump Coronary Artery Bypass Grafting in Left Ventricular Dysfunction

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

The Concept of Heart Failure: Chronic Diseases Accompanied by an Attack of Acute Exacerbation

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