Faculty Collaboration Database

Coronary bypass in left ventricular dysfunction and differential cardiac recovery. Asian Cardiovasc Thorac Ann 2017 Nov;25(9):586-593

Date

11/21/2017

Pubmed ID

29153000

DOI

10.1177/0218492317744472

Scopus ID

2-s2.0-85038589812 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

Background We aimed to examine the efficacy of surgical revascularization with respect to improvement in ventricular function and survival in patients with ischemic cardiomyopathy and poor left ventricular function. Methods We retrospectively analyzed the data of 429 patients (median age 64.6 years, 81.1% male) with ejection fractions <40% undergoing isolated primary coronary artery bypass grafting from 2000 to 2016. Techniques included on-pump cardioplegic arrest ( n = 312), off-pump ( n = 75), and on-pump beating heart ( n = 42). Propensity matching was performed to compare the cardioplegic arrest group ( n = 114) with the combined off-pump and beating heart groups ( n = 114). Results Postoperatively, ejection fraction increased by 10.1% ± 13.1% (from 31.4% ± 7.1% to 41.6% ± 13.6%; p < 0.001) and mitral regurgitation grade improved ( p < 0.001) but right ventricular function on echocardiographic assessment worsened over time ( p = 0.04). No difference in ejection fraction improvement was seen in the time periods <1 (9.8% ± 11.2%), 1-5 (11.6% ± 14.5%), and >5 (8.8% ± 14.2%) years ( p = 0.442). Following propensity matching, there was no significant difference between the combined off-pump/beating heart and cardioplegic arrest groups with respect to survival or postoperative complications. Conclusions Patients with moderate to severe left ventricular dysfunction experience long-term improvement in left ventricular ejection fraction after coronary artery bypass. However, right ventricular function often continues to decline, contributing to persistent or worsening heart failure symptoms and late mortality. No difference in survival was seen between the 2 techniques.

Author List

Lozonschi L, Kohmoto T, Osaki S, De Oliveira NC, Dhingra R, Akhter SA, Tang PC

Author

Takushi Kohmoto MD, PhD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cardiopulmonary Bypass
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease
Female
Heart Arrest, Induced
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Recovery of Function
Retrospective Studies
Risk Factors
Severity of Illness Index
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left
Ventricular Dysfunction, Right
Ventricular Function, Left
Ventricular Function, Right