COMPARISON OF EARLY AND LATE COMPLICATIONS IN PATIENTS UNDERGOING CORONARY-ARTERY BYPASS GRAFT-SURGERY WITH AND WITHOUT CONCOMITANT PLACEMENT OF AN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

Previous studies have reported a significant morbidity and mortality a ssociated with coronary artery bypass graft (CABG) surgery in conjunct ion with the placement of an implantable cardioverter defibrillator (I CD) with an epicardial lead system. In the absence of a control group, how significantly the component of concomitant placement of the ICD s ystem contributes to these untoward outcomes remains unknown. The purp ose of this study was to assess the short-and long-term complications in patients undergoing CABG surgery in conjunction with the placement of an ICD with epicardial leads and to compare these complications wit h those of patients who had only CABG surgery (control group). The stu dy group (group A) consisted of 56 patients who underwent CABG surgery and placement of an ICD pulse generator with epicardial leads. A cont rol group (group B) consisted of 56 patients who underwent CABG surger y only during the same time period. The two groups were matched for ag e, sex distribution, left ventricular function, surgical approach, num ber of bypass grafts per patient, bypass pump time, and length of foll ow-up period. The early mortality for group A was 7.1% versus 1.8% for group B (p > 0.05). The incidence of early morbidity (congestive hear t failure, infection, supraventricular and ventricular arrhythmias) fo r groups A and B was similar (26.8% vs 25.0%, p > 0.05). The incidence of late mortality and morbidity (progression of congestive heart fail ure, recurrence of coronary events, chronic atrial fibrillation) for g roups A and group B were 7.7% versus 5.5% (p > 0.05) and 23.1% versus 21.8% (p > 0.05), respectively. However, death caused by cardiopulmona ry difficulties was more frequent in group A than group B (12.5% vs 1. 8%, p < 0.05). With the availability of the nonthoracotomy lead system and the pulse generator capable of delivering biphasic shock waveform , to place such an ICD system at a later time after the CABG surgery a ppears to be the preferred approach to treat patients who need both su rgical coronary revascularization and ICD.