TY - JOUR
T1 - Results and Predictors of Early and Late Outcome of Coronary Artery Bypass Grafting in Patients With Severely Depressed Left Ventricular Function
AU - Filsoufi, Farzan
AU - Rahmanian, Parwis B.
AU - Castillo, Javier G.
AU - Chikwe, Joanna
AU - Kini, Annapoorna S.
AU - Adams, David H.
PY - 2007/9
Y1 - 2007/9
N2 - Background: Coronary artery bypass grafting (CABG) is a well-accepted therapeutic approach in patients with symptomatic multivessel coronary artery disease and severely depressed left ventricular function. However, the potential impact of off-pump CABG in this group of patients remains unknown. In addition, there are only scarce data regarding long-term survival and its predictors in this patient population. Methods: We retrospectively analyzed prospectively collected data of 2,725 consecutive patients (mean age, 65 ± 11 years; 843 (31%) female) undergoing CABG between January 1998 and December 2005 (ejection fraction [EF] ≤ 0.30; n = 495, 18%). Outcome measures included hospital mortality, major complications, and long-term survival. Multivariate analysis was performed to identify predictors of hospital mortality and late survival. Subgroup analysis for patients with EF less than or equal to 0.30 undergoing conventional CABG (n = 424, 86%) versus off-pump CABG (n = 71, 14%) was performed. Results: Hospital mortality was 1.8% (EF ≤ 0.30, 3.6%; EF > 0.30, 1.4%; p = 0.002). Off-pump CABG did not have an impact on operative mortality (on-pump, 4%; off-pump, 3%; p = 0.509). Ejection fraction of 0.30 or less was not an independent risk factor of hospital mortality but predicted respiratory failure (odds ratio [OR] = 2.3) and sepsis (OR, 1.4). Long-term survival was significantly decreased in patients with EF of 0.30 or less: 1-year and 5-year survival 88% ± 1.5% and 75% ± 2.2% versus 96% ± 0.4% and 81% ± 1.2%, respectively (p = 0.001). Reoperation (OR, 6.9), peripheral vascular disease (OR, 3.2), chronic obstructive pulmonary disease (OR, 3.0), congestive heart failure (OR, 2.7), and female sex (OR, 2.1) were independent predictors of long-term survival. Conclusions: Excellent results after CABG can be expected in patients with EF of 0.30 or less, with minimal increase in mortality and acceptable postoperative morbidity. Long-term survival remains limited, but recent results are substantially better than historical reports. Careful preoperative patient selection and perioperative management are essential in these patients undergoing CABG.
AB - Background: Coronary artery bypass grafting (CABG) is a well-accepted therapeutic approach in patients with symptomatic multivessel coronary artery disease and severely depressed left ventricular function. However, the potential impact of off-pump CABG in this group of patients remains unknown. In addition, there are only scarce data regarding long-term survival and its predictors in this patient population. Methods: We retrospectively analyzed prospectively collected data of 2,725 consecutive patients (mean age, 65 ± 11 years; 843 (31%) female) undergoing CABG between January 1998 and December 2005 (ejection fraction [EF] ≤ 0.30; n = 495, 18%). Outcome measures included hospital mortality, major complications, and long-term survival. Multivariate analysis was performed to identify predictors of hospital mortality and late survival. Subgroup analysis for patients with EF less than or equal to 0.30 undergoing conventional CABG (n = 424, 86%) versus off-pump CABG (n = 71, 14%) was performed. Results: Hospital mortality was 1.8% (EF ≤ 0.30, 3.6%; EF > 0.30, 1.4%; p = 0.002). Off-pump CABG did not have an impact on operative mortality (on-pump, 4%; off-pump, 3%; p = 0.509). Ejection fraction of 0.30 or less was not an independent risk factor of hospital mortality but predicted respiratory failure (odds ratio [OR] = 2.3) and sepsis (OR, 1.4). Long-term survival was significantly decreased in patients with EF of 0.30 or less: 1-year and 5-year survival 88% ± 1.5% and 75% ± 2.2% versus 96% ± 0.4% and 81% ± 1.2%, respectively (p = 0.001). Reoperation (OR, 6.9), peripheral vascular disease (OR, 3.2), chronic obstructive pulmonary disease (OR, 3.0), congestive heart failure (OR, 2.7), and female sex (OR, 2.1) were independent predictors of long-term survival. Conclusions: Excellent results after CABG can be expected in patients with EF of 0.30 or less, with minimal increase in mortality and acceptable postoperative morbidity. Long-term survival remains limited, but recent results are substantially better than historical reports. Careful preoperative patient selection and perioperative management are essential in these patients undergoing CABG.
UR - http://www.scopus.com/inward/record.url?scp=34548083664&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2007.04.117
DO - 10.1016/j.athoracsur.2007.04.117
M3 - Article
C2 - 17720380
AN - SCOPUS:34548083664
SN - 0003-4975
VL - 84
SP - 808
EP - 816
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -