Can coronary artery bypass grafting be a treatment of choice in patients with extremely poor left ventricular function?

ABSTRACT

Advanced ischemic heart disease [IHD] with very low left ventricular ejection fraction [LVEF], pulmonary hypertension [PHT] with or without left ventricular aneurysm [LVA] are criteria for defining end-stage coronary artery disease [ESCAD]. Coronary artery bypass grafting is often denied to these patients.Between January 1,1990 and March 1,1995,145 patients with ESCAD, significant 2 or 3-vessel disease [stenosis > 70%] and LVEF men. The mean NYHA class was 3.7 +/- 0.5. Mean left ventricular ejection fraction [LVEF] was 19.6 +/- 4.3% [10-25]. Mitral regurgitation [MR] was present in 58/145 [40%]. Twenty two patients had significant pulmonary artery hypertension preoperatively, with a systolic PAP >/= 40 mmHg. The overall perioperative mortality was 13.1%. The mortality rate after primary CABG was 12.1%. Low postoperative cardiac output occurred in 41 patients, requiring intraaortic balloon support in 16. Gastrointestinal complications occurred in 7 patients and neurological events in two. Other perioperative complications did not differ. At an average 19 months follow up of 109 hospital survivors, all improved their NYHA class to 1.6 +/- 0.4, mean ergometry tolerance was 93 +/- 32 W and an improved LVEF was achieved, 45.2 +/- 9.1, p < 0.001, without any mortality. All patients improved their MR with at least one grade compared to preoperatively and none has yet required a mitral valve intervention. The 3 year survival rate was 86% and the cardiac event-free survival rate was 79% at 3 years. In Combination of LVEF pulmonary artery hypertension and mitral regurgitation is not a contraindication for primary CABG provided that the patient presents with significant myocardial ischemia