CORONARY-ARTERY BYPASS-GRAFTING AND HEART-TRANSPLANTATION IN END-STAGE CORONARY-ARTERY DISEASE - A COMPARISON OF HEMODYNAMIC IMPROVEMENT AND VENTRICULAR-FUNCTION

Heart transplantation has now become an accepted treatment for end-sta ge coronary heart disease (CAD). However, the limited supply of suitab le donor organs imposes constraints upon the decision of whether patie nts are selected for transplantation or for coronary artery bypass gra fting (CABG). From April 1986 until the end of March 1992, 265 patient s with end-stage CAD involving left ventricular ejection fraction (LVE F) 10% to 30% and predominant angina pectoris underwent CABG. All pati ents received an average of 2.9 +/- 0.3 venous grafts. Intraaortic bal loon pumps were implanted in 30 patients (11.3%) who began to develop low cardiac output syndrome intraoperatively. The actuarial survival r ate was 87.8% after 2 years and 86.9% after 3 years. LVEF was measured in 35 patients via left heart catheterization 12 months after their o perations and was found to have increased from a mean of 23.8% to 38.1 %. Left ventricular end-diastolic pressure had decreased from 16.2 mmH g to an average of 12.1 mmHg. Swan-Ganz catheterization was performed on 120 patients 6 months postoperatively. The pulmonary wedge pressure had reduced significantly from 18.1 mmHg to a mean of 12.7 mmHg (p < 0.01). From 1990 until the end of March 1992, 55 patients with CAD and predominant heart failure received transplants. Their 2-year survival rate was 66.3%. Mean LVEF was 55.6% postoperatively. We conclude that CABG is adequate for patients who have end-stage CAD and angina pecto ris symptoms, and that it significantly improves hemodynamic functions . Patients suffering predominantly from heart failure (NYHA Class IV) can be transplanted and subsequently regain normal heart function.