LATE SURVIVAL (AVERAGE 7 YEARS) AFTER COR ONARY-BYPASS SURGERY IN PATIENTS WITH SEVERE LEFT-VENTRICULAR DYSFUNCTION

The inclusion criteria of this study were a left ventricular ejection fraction of less than 40 % with global left ventricular hypokinesis: l eft ventricular aneurysms and valvular lesions were excluded. From Jan uary 1970 to December 1990, 155 patients fulfilling these criteria had Class III or IV angina and 49 patients had Class II or III dyspnoea. The average left ventricular ejection fraction was 31 +/- 7 %. Over th is 20 year period two surgical techniques were used : Group I (79 pati ents operated between 1970 and 1981) myocardial revascularisation with intermittent aortic clamping by an internal mammary artery pedicle on the left anterior descending artery and simple venous bypass grafts; Group II (76 patients operated between 198 and 1990) myocardial revasc ularisation under oxygenated cardioplegia by internal mammary artery p edicle on the left anterior descending artery associated with sequenti al venous bypass grafts. The average number of bypass grafts was 1.6 i n Group I and 3,7 in Group II (p = 0,001). The early postoperative mor tality (first month) was 5,2 % it was lower in Group II (2,6 %) than i n Group I (7,6 %) (p = 0.01). After 79 +/- 14 months follow-up, 6 pati ents were lost to follow-up, 51 patients had died secondarily and ther e were 90 survivors. Globally, 80 % of deaths were of cardiac origin, 38 % from cardiac failure. The actuarial 5, 10 and 15 year survival ra tes were 79 +/- 7 %, 63 +/- 10 % and 36 +/- 15 % respectively. The 5 y ear survival in Group I was 71 +/- 10 % compared with 98 +/- 8 % in Gr oup II (p = 0,02). Preoperative left ventricular ejection fraction and myocardial protection were independant prognostic factors for early d eath and longterm survival (p = 0,05). Long term functional results we re related to complete myocardial revascularisation (p = 0,01). The re sults of coronary bypass surgery in patients with severe left ventricu lar dysfunction are satisfactory despite the problem of long term dete rioration of myocardial function.