CORONARY SURGERY CAN BE AN ALTERNATIVE TO HEART-TRANSPLANTATION IN SELECTED PATIENTS WITH END-STAGE ISCHEMIC-HEART-DISEASE

Patients with ischemic heart disease (IHD) low ejection fraction (EF), and congestive heart failure (CHF), are usually referred for orthotop ic heart transplantation (OHT). This study reports our experience with coronary artery bypass grafting (CABG) in patients initially referred for OHT, and suggests guidelines to facilitate the choice of procedur e (OHT or CABG). Between January 1990 and December 1991, 32 patients w ith IHD, proposed for OHT, underwent CABG 31/32 patients were male, th e mean age was 58 +/- 12 years (40 to 70). Congestive heart failure wa s present in all patients and was the main symptom. The mean EF was 23 (14 to 31%), mean cardiac index (CI) 2.4 I/min per m2 (1.6 to 3.1 I/m in per m2), mean pulmonary artery mean pressure (MPAP) 26 (20 to 37 mm Hg) and mean pulmonary wedge pressure 16 (12 to 22 mmHg). Every patien ts underwent a myocardial viability study by thallium scintigraphy (n = 32) and/or by positron emission tomography (n = 10). The perioperati ve mortality was 9.3% (3/32). All long-term survivors (n = 27) are in NYHA Class II with a complete follow-up (mean 18 +/- 6 months). Ejecti on fraction control either by angiography (n = 15) or by single photon emission computed tomography (n = 12) showed an increase of up to 38% (22%-46%). Three determinant factors influenced the choice of CABG. 1 ) CI > 2 l/min per m2, 2) MPAP < 35 mmHg. 3) Detection of myocardial v iability. In conclusion, CABG is a reasonable alternative to OHT in se lected patients with IHD and CHF since 1) the operative mortality is l ower, 2) our patients have all improved significantly, 3) no late OHT was necessary and 4) there was an absence of immunosuppression and con straining follow-up.