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The Annals of Thoracic Surgery, Vol 56, 487-493, Copyright © 1993 by The Society of Thoracic Surgeons
CA Milano, WD White, LR Smith, RH Jones, JE Lowe, PK Smith and P Van Trigt 3d
This study evaluates whether patients with coronary artery disease and
severely depressed left ventricular ejection fraction benefit from coronary
artery bypass grafting. From 1981 to 1991, 118 consecutive patients with
ejection fraction less than or equal to 0.25 underwent isolated coronary
artery bypass grafting at Duke University Medical Center. Operative
mortality was 11%. Ventricular arrhythmia requiring treatment was the most
common postoperative complication (27%), followed by low cardiac output
state (22%). Median length of postoperative hospitalization was 9 days.
Kaplan-Meier estimate of survival at 1 year and 5 years was 77.2% and
57.5%, and was better than estimated survival with medical therapy alone.
Survivors experienced significant improvement in angina class (p <
0.0001), congestive failure class (p < 0.0001), and follow-up ejection
fraction (p < 0.005). Of 22 preoperative factors evaluated by univariate
survival analysis, five were associated with significantly greater
mortality: other vascular disease (p < 0.005), female sex (p <
0.005), hypertension (p < 0.005), elevated left ventricular
end-diastolic pressure (p < 0.05), and depressed cardiac index (p <
0.05). Considering length of hospitalization, three factors showed
significant adverse effect in a multivariate Cox model: time on
cardiopulmonary bypass (p < 0.005), acute presentation (p < 0.005),
and female sex (p < 0.01). These data and review of the literature
suggest that patients with coronary artery disease and severely depressed
ejection fraction benefit from coronary artery bypass grafting, and
specific preoperative factors may help determine optimal treatment.
ARTICLES
Coronary artery bypass in patients with severely depressed ventricular function
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
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