Evaluation of coronary artery bypass grafting [CABG] outcome versus medical treatment in patients with poor LV function

ABSTRACT

Coronary artery bypass grafting [CABG] in patients with Coronary Artery Disease [CAD] is associated with improved survival compared with medical treatment. Historically, CABG in patients with Left ventricular dysfunction [LVD] has been associated with high post operative mortality. However, Major randomized control studies comparing medical therapy with [CABG] did not recruit patients with a left ventricular [LV] ejection fraction 30%. They did, however, demonstrate improved survival in surgically treated patients with milder degrees of LV systolic dysfunction. The aim of this work is to evaluate the outcome of CABG versus medical treatment in patients with coronary artery disease [CAD] and ejection fraction 30% or less [EF<30%], and to evaluate of preoperative risk factors that predict short-term survival after coronary artery bypass grafting in patients with ejection fraction 30% or less. Our retrospective study consisted of Forty six patients with low EF [30%], who received the standard medical treatment in King Faisal Specialist Hospital and Research Centre [Group A, other 39 patients who underwent isolated CABG between May 2002 and December 2005 at North West Army Force Hospital KSA. [Group B. Patient characteristics were reasonably matched between the groups. Patients with a history of concomitant valve surgery, aneurysmectomy, respiratory or renal failure, were excluded from the study. Diagnosis was based on standard clinical, echocardiographic and prior angiographic criteria. The total number of deaths in the first month after establishment of treatment whether medical or CABG was 3 [6.52%] in group A and 3 [7.7%] in group B. Early mortality in both groups of patients with poor LV was significantly evident in Diabetic patients, history of MI less than 4 weeks and or Left main lesion. The use of blood cardioplagia intra-operative was associated with higher mortality than other variables in group B patients. During the follow-up period, the complications and side effects during one year was significantly more evident in group A who received the standard medical treatment only compared to group who were operated upon. The Relapse of H.F at least once or more was 41% in Group A and 30% required rehospitalization compared to 15.4% of Group B patients got one or more Relapses of H.F and 10.2%. The Cardiac Deaths were 26.1% in Group A while it was 10.2% only in Group B. The current study demonstrates that patients with significant LV systolic dysfunction undergoing isolated first CABG using current techniques have a good short and long-term survival, the preoperative risk factors as age, male gender, DM, hypertension, prior MI, and emergency operation had an effect on short term survival but significant impact on the length of hospital stay. The usage of CABS markedly improves survival in patients with 3 vessel disease or left main stenosis [LMS]. It is safe regardless the poor preoperative LVEF