CORONARY-BYPASS WITH EJECTION FRACTION OF 0.20 OR LESS USING CENTIGRADE CARDIOPLEGIA - LONG-TERM FOLLOW-UP

Forty-two patients with an ejection fraction of 0.20 or less underwent coronary artery bypass grafting from 1986 to 1990 using a method of m yocardial protection we term ''centigrade cardioplegia,'' combining si ngle-dose, cold, crystalloid cardioplegia, systemic hypothermia, and l ocal hypothermia. Thirty-day mortality was 4.8% (2/42). Perioperative morbidity included-two myocardial infarctions (4.8%) and one stroke (2 .4%), which fully resolved. Postoperative left ventricular function im proved (left ventricular ejection fraction, 0.157 +/- 0.028 to 0.226 /- 0.085; p < 0.0002), as did New York heart Association class (3.4 +/ - 0.73 to 1.8 +/- 0.63; p < 0.0001) and Canadian class (3.3 +/- 0.81 t o 0.61 +/- 0.92). Survival, 88% at 1 year, declined to 68% at 3 years and 34% at 6 years. This high-risk group had very acceptable short-ter m results, indicating adequate intraoperative myocardial protection. F our clinical variables were associated with long-term survival: (1) ch ief complaint of pain only (p = 0.05), (2) history of unstable angina (p = 0.04), (3) Canadian class less than IV (p = 0.05), and (4) New Yo rk Heart Association class less than IV (p = 0.05). Reduced survival, although not statistically significant (p = 0.07), was noted for right ventricular ejection fraction of 0.30 or less. These factors may help predict which patients with severe left ventricular dysfunction will benefit from revascularization.