LATE RESULTS WITH CONCOMITANT CORONARY-ARTERY BYPASS-GRAFTING AND ICDIMPLANTATION

Background: To determine the influence of left ventricular function on the longterm survival of patients with coronary artery disease and le thal ventricular arrhythmias, who undergo concomitant coronary artery bypass grafting (CABG) and implantable cardiovertor defibrillator (ICD ) implantation, we studied survival in 54 consecutive patients who und erwent CABG and ICD implantation. Methods: Group I consisted of 35 pat ients with left ventricular ejection fraction (LVEF) less than or equa l to 35% (mean 25.3 +/- 5.6) and Group II consisted of 19 patients wit h LVEF > 35% (mean 47.5 +/- 6.6). The two groups were similar with reg ards to age, gender, clinical presentation, induced arrhythmias, and t he number of grafts placed at the time of surgery. Results: Two in-hos pital deaths (3.7%) occurred, both in Group I. During follow-up (42.5 +/- 21.8 months), there were 10 deaths in Group I (1 noncardiac, 1 sud den, and 8 heart failure), and 1 death in Group II (heart failure) (p < 0.04). Conclusions: Concomitant CABG and ICD implantation can be per formed with an acceptable in-hospital mortality, even in patients with poor left ventricular function. Although freedom from sudden cardiac death remains excellent, overall long-term survival is limited by refr actory heart failure, especially in those patients with left ventricul ar dysfunction at the time of surgery.