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Ann Thorac Surg 2002;74:2082-2087
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Revascularization in severe ventricular dysfunction (15% LVEF 30%): a comparison of bypass grafting and percutaneous intervention

^a Department of Surgery and Cardiology, New Orleans, Louisiana, USA

Accepted for publication July 26, 2002.

* Address reprint requests to Dr Van Meter, Division of Thoracic Cardiovascular Surgery, Department of Surgery, Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 07121; USA.
e-mail: cvanmeter{at}ochsner.org

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

BACKGROUND: We sought to determine the optimal approach to revascularization of patients with severe left ventricular (LV) dysfunction.

METHODS: We conducted a single-center observational study of 117 consecutive patients who had severe LV dysfunction (15% LV ejection fraction 30%) and underwent either coronary artery bypass grafting (CABG, n = 69) or percutaneous revascularization (n = 48) between 1992 and 1997.

RESULTS: The CABG group was younger (62 versus 67 years, p = 0.026), and fewer previous bypasses (7% versus 40%, p < 0.0001) and fewer prior percutaneous revascularizations (16% versus 42%, p = 0.0019) were noted. More vessels were revascularized (3 ± 0.8 versus 1.5 ± 0.7, p < 0.0001), and revascularization was more complete by CABG (84% versus 48%, p < 0.0001). Morbidity and mortality at 30 days were similar, and there was no significant difference in 3-year survival (73% versus 67%), although 3-year cardiac event-free survival (52% versus 25%, p = 0.0011) and 3-year target vessel revascularization–free survival (71% versus 41%, p < 0.0001) were significantly better in the CABG group, and LV ejection fraction was significantly improved after CABG. In the subgroup of patients 65 years of age or older and those without proximal left anterior descending coronary artery lesions, significant benefit of CABG in cardiac event-free and target vessel revascularization–free survival disappeared.

CONCLUSIONS: We found that in clinically selected patients with severe ventricular dysfunction, CABG compared with percutaneous revascularization achieves more complete revascularization, improved LV function, fewer cardiac events, and fewer target vessel revascularizations, but does not affect mid-term survival. A prospective controlled trial with defined criteria for treatment assignment is warranted to confirm our results regarding the two revascularization strategies in patients with severe LV dysfunction.

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