Early outcome of coronary artery bypass surgery in patients with poor left ventricular function

• Main Authors: Saeed Elassy, Hatem El-Bawab, Mohamed Abd El fatah
• Format: Article
• Language: English
• Published: SpringerOpen 2014-03-01
• Series: The Egyptian Heart Journal
• Online Access: http://www.sciencedirect.com/science/article/pii/S1110260813001440

Surgical revascularization in patients with poor left ventricular function has historically carried a high mortality and morbidity rates. However, with advances in surgical techniques and myocardial protection, the safety of CABG in those patients has been demonstrated. Objectives: The aim of this study is to investigate the early surgical outcome in patients with poor left ventricular function (EF < 35%) in comparison with patients having normal left ventricular function (EF > 50%). Material and methods: This study included 155 patients with ischaemic heart disease, that were retrospectively grouped into, group I including 71 patients with a left ventricular function <0.35 and group II including 84 patients with normal left ventricular function (>0.50). All patients were subjected to conventional CABG with the use of cardiopulmonary bypass. There are more males in group I (63, 88.7%, P < 0.012), and patients in this group tend to be more obese, had more incidences of hypertension (43, 60.6%, P < 0.036), hypercholestermia (26, 36.6, P < 0.006) and Diabetes (40, 56.30%, P < 0.006). Also they tend to have more incidences of MI (46, 64.8%, P < 0.001), CHF (34, 66.7%, P < 0.001) and higher mean NYHA (2.3±0.5, P < 0.001). Otherwise, there was no statistically significant difference between both groups. Results: The overall in-hospital mortality was 3.9% (n = 6). Four patients died in group I (5.6%) and 2 in group II (2.4%). There was a significantly longer mean bypass time and cross-clamp time in group I (81.4 ± 12 versus 66.6 ± 12.1 min; P < 0.001 and 43.7 ± 7.3 versus 36.5 ± 5.9 min; P < 0.001, respectively). Also, Patients in group I had more prolonged ICU stay (58.3 ± 11.2 versus 41.8 ± 11.6 h; P < 0.001), more patients needed IABP (24 patients, 33.8% versus 6 patients, 7.1%, P < 0.001); and more patients needed positive inotropic support (55 patients, 77.5% versus 39 patients, 46.4%, P < 0.001) compared to Group II patients. There was highly significant improvement in postoperative NYHA class in both groups(P < 0.001), however there were more improvement in group I (33.1, 95% confidence interval 26.22 to 39.98 versus 30.1, 95% CI 24.07 to 36.24). EF has significantly improved in group I postoperatively (P < 0.001), however, there were no statistical difference in group II. Other postoperative outcomes were insignificantly different between compared groups. Conclusions: CABG in patients with poor function can be performed with low mortality and morbidity. Low ejection fraction does not preclude CABG provided careful patient selection is implemented.