CORONARY-ARTERY BYPASS-GRAFTING IN PATIENTS WITH CHRONIC CONGESTIVE-HEART-FAILURE - A 10-YEAR EXPERIENCE WITH 203 PATIENTS

From 1983 to 1992, 203 patients with chronic congestive heart failure and no angina underwent primary coronary artery bypass. This represent ed 3% of patients undergoing coronary artery bypass grafting. Ninety-t wo percent of the patients were in New York Heart Association (NYHA) f unctional class III or IV prior to undergoing coronary artery bypass g rafting. Thallium perfusion imaging was performed in 21% of the patien ts, with a reversible defect present in 88%. An internal mammary arter y graft was used in 70% of the patients. The hospital mortality was 6. 0% and the actuarial survival at 5 years was 59%. An improvement in NY HA functional class occurred in 75% of the surviving patients with a m ean improvement of 1.6 +/- 0.6 functional classes. Univariate analysis identifed risk factors for hospital death as emergency operation, rec ent myocardial infarction (< 30 days), and the need for an intra-aorti c balloon pump. A trend emerged for nonuse of an internal mammary arte ry to predict hospital death. A positive thallium perfusion scan was n ot a predictor of early or tate survival, nor did it influence NYHA fu nctional class. The use of the internal mammary artery signifcantly en hanced late survival (p = 0.01), however, did not affect the functiona l class of survivors. We conclude that coronary artery bypass grafting is effective in ameliorating symptoms of chronic congestive heart fai lure in patients suffering from chronic ischemic cardiomyopathy and ca n be performed with acceptable early and late mortality.