CORONARY-BYPASS SURGERY IN PATIENTS WITH SEVERE LEFT-VENTRICULAR DYSFUNCTION (EF-LESS-THAN-OR-EQUAL-TO-25-PERCENT) - RESULTS IN A SERIES OF111 PATIENTS

One hundred and eleven patients with severe left ventricular dysfuncti on (EF less than or equal to 25 %) underwent coronary bypass surgery b etween January 1984 and December 1994. The selection criteria were bas ed on the measurement of an EF less than or equal to 25 %, LVEDP and C I. All patients had angina and 83 had signs of pulmonary oedema or epi sodes of congestive cardiac failure. Patients with valvular disease, l eft ventricular aneurysms, reoperations, surgery for arrhythmias and p rior angioplasty, were excluded. The coronary disease usually involved all three vessels. Seventeen patients had lesions of the left main st em associated with lesions of the right coronary artery. The average n umber of bypass grafts was 2.6+/-1.6 per patient. The average duration of aortic clamping was 60+/-19 minutes. Operative mortality (first mo nth after surgery) was 10 patients (9 %). The operative risk factors w ere : gender, stage of cardiac failure, emergency surgery, LVEDP >23 m mHg (p <0.05), CI <21min/m(2) (p <0.05). The mean follow-up period was 42+/-12 months (3 lost to follow-up). Late mortality was 42 patients. The one year actuarial survival was 88+/-5.3%, 76+/-9% at 3 years, an d 56+/-18% at 6 years. Long-term functional results were related to:pr eoperative stage of cardiac failure (NYHA stage IV) and the associatio n of raised LVEDP and low CI. Surgical results remained satisfactory h owever, and the surgical indication was justified in selected patients despite severe left ventricular dysfunction in cases usually with sta ble invalidating or unstable angina, in the knowledge that myocardial deterioration is progressive in the medium-term with a high incidence of cardiac failure.