IS REOPERATIVE CORONARY-ARTERY BYPASS-GRAFTING IN PATIENTS WITH POOR LEFT-VENTRICULAR EJECTION FRACTIONS-LESS-THAN-OR-EQUAL-TO-25-PERCENT WORTHWHILE

Aim: This study aimed to investigate whether patients with very low le ft ventricular ejection fractions (LVEF) should be accepted for reoper ative coronary artery bypass grafting (CABG). Study population: Betwee n January 1990 and December 1993, 1681 patients underwent primary CABG and 308 (15.5%) reoperative CABG. One hundred and eight patients (5.4 %) had an LVEF less than or equal to 25%, 91 patients for primary CABG (group I) and 17 for CABG (group II). The mean age of the patients wa s 62 years. Sex distribution and preoperative risk factors did not dif fer. Urgent operations were more frequently necessary in group II (P < 0.01). Mitral regurgitation was present in 49% of the group I patient s and 18% of the group II patients (P < 0.05). Pulmonary artery hypert ension was observed in 24% of group I patients, but in only 6% in grou p II patients. The mean LVEF was 21% and left ventricular end-diastoli c pressure 18 mmHg, without between-group differences. All patients ha d significant two- or three-vessel disease (stenosis greater than or e qual to 70%). An average of 4.5 grafts per patient were performed. Mit ral valve surgery was not performed in any of the patients. Results: T he postoperative mortality was significantly higher in in reoperative CABG patients (group II; 23.5%) than in group I patients (12.1%; P < 0 .05), whereas the incidence of non-fatal myocardial infarction did not differ. The incidence of postoperative complications did not differ b etween the groups, except for transient renal failure, more frequently encountered in group II (P < 0.05). After an average follow-up of 18 months, the New York Heart Association (NYHA) class and the LVEF were significantly improved in both groups (NYHA class from 3.5 to 1.8 and LVEF from 21% to 45%; P < 0.001). The mitral regurgitation had improve d or completely disappeared at the end of follow-up in all patients in both groups. Conclusions: Our results suggest that patients with left ventricular ejection fraction less than or equal to 25%, angina and s ignificant two- or three-vessel coronary artery disease should not cat egorically be refused for reoperative CABG. Careful patient selection is necessary because of an increased operative risk.