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The Annals of Thoracic Surgery, Vol 56, 480-485, Copyright © 1993 by The Society of Thoracic Surgeons
SL Lansman, M Cohen, JD Galla, J Machac, CS Quintana, MA Ergin and RB Griepp
Forty-two patients with an ejection fraction of 0.20 or less underwent
coronary artery bypass grafting from 1986 to 1990 using a method of
myocardial protection we term "centigrade cardioplegia," combining
single-dose, cold, crystalloid cardioplegia, systemic hypothermia, and
local hypothermia. Thirty-day mortality was 4.8% (2/42). Perioperative
morbidity included two myocardial infarctions (4.8%) and one stroke (2.4%),
which fully resolved. Postoperative left ventricular function improved
(left ventricular ejection fraction, 0.157 +/- 0.028 to 0.226 +/- 0.085; p
< 0.0002), as did New York Heart Association class (3.4 +/- 0.73 to 1.8
+/- 0.63; p < 0.0001) and Canadian class (3.3 +/- 0.81 to 0.61 +/-
0.92). Survival, 88% at 1 year, declined to 68% at 3 years and 34% at 6
years. This high-risk group had very acceptable short-term results,
indicating adequate intraoperative myocardial protection. Four clinical
variables were associated with long-term survival: (1) chief complaint of
pain only (p = 0.05), (2) history of unstable angina (p = 0.04), (3)
Canadian class less than IV (p = 0.05), and (4) New York Heart Association
class less than IV (p = 0.05). Reduced survival, although not statistically
significant (p = 0.07), was noted for right ventricular ejection fraction
of 0.30 or less. These factors may help predict which patients with severe
left ventricular dysfunction will benefit from revascularization.
ARTICLES
Coronary bypass with ejection fraction of 0.20 or less using centigrade cardioplegia: long-term follow-up
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY 10029.
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